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General NPI Number Information
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NPI Number | 1548669294
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Entity Type | Organization
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Legal Business Name | VALENCIA FAMILY DENTAL
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 3472 STATE HIGHWAY 47
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City | LOS LUNAS
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State | NM
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Zip | 87031-8222
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Country | US
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Telephone | 505-865-9788
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Fax | 505-565-0422
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Provider Business Mailing Address
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Address Line | PO BOX 1298
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City | LOS LUNAS
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State | NM
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Zip | 87031-1298
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Country | US
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Telephone | 505-865-9788
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Fax | 505-565-0422
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIC M SMITH
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Credential | DDS
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Telephone | 505-865-9788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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