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General NPI Number Information
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NPI Number | 1558666883
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Entity Type | Organization
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Legal Business Name | PLAINS DENTAL
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Dates
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Enumeration Date | 01/18/2011
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 121 W LLANO ESTACADO BLVD
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City | CLOVIS
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State | NM
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Zip | 88101
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Country | US
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Telephone | 575-742-3100
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Fax | 575-742-3400
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Provider Business Mailing Address
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Address Line | 121 W LLANO ESTACADO BLVD
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City | CLOVIS
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State | NM
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Zip | 88101
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Country | US
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Telephone | 575-742-3100
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Fax | 575-742-3400
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Authorized Official
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Title or Position | OWNER
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Name | MS. JULIE A O'QUINN
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Credential | D.D.S.
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Telephone | 575-742-3100
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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 | DD3395
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH1504
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH2245
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH2884
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License Number State | NM
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Taxonomy #5
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | DA3975
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License Number State | NM
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Taxonomy #6
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | DA2349
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License Number State | NM
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Taxonomy #7
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DD1887
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License Number State | NM
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