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General NPI Number Information
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NPI Number | 1538959051
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Entity Type | Organization
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Legal Business Name | ENDODONTICS OF NEW MEXICO
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 539 HARKLE RD STE C
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City | SANTA FE
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State | NM
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Zip | 87505-4783
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Country | US
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Telephone | 617-686-6629
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Fax |
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Provider Business Mailing Address
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Address Line | 1852 FOREST CIR
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City | SANTA FE
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State | NM
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Zip | 87505-4505
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Country | US
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Telephone | 617-686-6629
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CYROUS ARDALAN
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Credential | DMD
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Telephone | 617-686-6629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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