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General NPI Number Information
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NPI Number | 1598143257
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Entity Type | Organization
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Legal Business Name | DEMING ORTHODONTICS, LLC
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Dates
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Enumeration Date | 05/14/2015
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Last Update Date | 05/14/2015
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Provider Practice Location Address
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Address Line | 710 S GOLD AVE
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City | DEMING
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State | NM
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Zip | 88030-4161
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Country | US
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Telephone | 303-887-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 710 S GOLD AVE
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City | DEMING
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State | NM
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Zip | 88030-4161
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Country | US
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Telephone | 303-887-4400
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Fax |
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Authorized Official
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Title or Position | OWNER/ORTHODONTIST
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Name | ROBERT E. BREWKA
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Credential | DDS
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Telephone | 303-887-4400
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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 | DD4015
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License Number State | NM
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