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General NPI Number Information
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NPI Number | 1619625704
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Entity Type | Organization
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Legal Business Name | STF DENTAL
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Dates
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Enumeration Date | 03/17/2022
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Last Update Date | 03/17/2022
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Provider Practice Location Address
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Address Line | 5805 MCNUTT RD
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City | SANTA TERESA
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State | NM
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Zip | 88008-8001
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Country | US
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Telephone | 213-200-5023
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Fax |
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Provider Business Mailing Address
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Address Line | 11368 ACOMA ST
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City | EL PASO
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State | TX
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Zip | 79934-2872
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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 | DR. SOO JUN
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Credential |
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Telephone | 213-200-5023
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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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