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General NPI Number Information
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NPI Number | 1558946855
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Entity Type | Organization
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Legal Business Name | ORTHODONTICS LC3, LLC
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Dates
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Enumeration Date | 03/17/2021
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 920 N TELSHOR BLVD
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City | LAS CRUCES
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State | NM
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Zip | 88011-8277
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Country | US
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Telephone | 575-521-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 920 N TELSHOR BLVD
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City | LAS CRUCES
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State | NM
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Zip | 88011-8277
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEITH C COOMBS
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Credential | D.D.S.
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Telephone | 575-521-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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