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General NPI Number Information
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NPI Number | 1669923173
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Entity Type | Organization
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Legal Business Name | ALAMOGORDO ORTHODONTICS LLC
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 516 1ST ST SUITE K
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City | ALAMOGORDO
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State | NM
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Zip | 88310-6511
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Country | US
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Telephone | 575-434-1275
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Fax |
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Provider Business Mailing Address
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Address Line | 516 1ST ST SUITE K
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City | ALAMOGORDO
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State | NM
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Zip | 88310-6511
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Country | US
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Telephone | 575-434-1275
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Fax | 575-434-1110
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Authorized Official
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Title or Position | DENTIST
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Name | DR. BRIAN WARD
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Credential | DDS, MS
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Telephone | 575-434-1275
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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 | DD4468
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License Number State | NM
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