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General NPI Number Information
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NPI Number | 1770893646
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Entity Type | Organization
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Legal Business Name | CONQUISTADOR DENTAL, LLC
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 07/31/2012
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Provider Practice Location Address
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Address Line | 704 CHRISTOPHER DR
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City | BELEN
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State | NM
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Zip | 87002-2629
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Country | US
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Telephone | 505-864-2055
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Fax |
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Provider Business Mailing Address
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Address Line | 704 CHRISTOPHER DR
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City | BELEN
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State | NM
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Zip | 87002-2629
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Country | US
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Telephone | 505-864-7000
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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. ROLAND KENT SANCHEZ II
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Credential | DDS
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Telephone | 505-864-7000
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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 | DD3285
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License Number State | NM
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