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General NPI Number Information
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NPI Number | 1811288699
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Entity Type | Organization
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Legal Business Name | CLARICE K. PICK, D.D.S., P.C.
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 125-A SIRINGO ROAD
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City | SANTA FE
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State | NM
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Zip | 87505-5709
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Country | US
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Telephone | 505-982-0094
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Fax | 505-982-9993
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Provider Business Mailing Address
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Address Line | 125-A SIRINGO ROAD
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City | SANTA FE
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State | NM
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Zip | 87505-5709
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Country | US
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Telephone | 505-982-0094
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Fax | 505-982-9993
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. CLARISE K. PICK
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Credential | D.D.S.
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Telephone | 505-982-0094
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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 | 1607
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License Number State | NM
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