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General NPI Number Information
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NPI Number | 1689847576
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Entity Type | Organization
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Legal Business Name | DENTAL FITNESS, PC
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Dates
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Enumeration Date | 04/11/2008
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Last Update Date | 04/11/2008
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Provider Practice Location Address
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Address Line | 444 SAINT MICHAELS DR STE B
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City | SANTA FE
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State | NM
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Zip | 87505-7674
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Country | US
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Telephone | 505-989-8749
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Fax |
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Provider Business Mailing Address
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Address Line | 444 SAINT MICHAELS DR STE B
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City | SANTA FE
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State | NM
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Zip | 87505-7674
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Country | US
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Telephone | 505-989-8749
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOYCE HORN
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Credential | MS, RDH
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Telephone | 505-989-8749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH2543
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License Number State | NM
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