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General NPI Number Information
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NPI Number | 1750484853
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Entity Type | Organization
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Legal Business Name | DENTAL ASSOCIATES PA
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 2205 S SOLANO DR
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City | LAS CRUCES
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State | NM
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Zip | 88001
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Country | US
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Telephone | 505-522-7320
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Fax | 505-522-6395
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Provider Business Mailing Address
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Address Line | 2205 S SOLANO DR
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City | LAS CRUCES
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State | NM
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Zip | 88001
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Country | US
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Telephone | 505-522-7320
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Fax | 505-522-6395
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID A. SUDIMACK
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Credential | D.D.S.
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Telephone | 575-522-7320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | NM1518
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | NM2258
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License Number State | NM
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