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General NPI Number Information
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NPI Number | 1831410745
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Entity Type | Organization
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Legal Business Name | NEW MEXICO SMILES, INC.
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 06/15/2010
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Provider Practice Location Address
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Address Line | 3812 BENJAMIN DAVIS DR
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City | CLOVIS
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State | NM
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Zip | 88101-2721
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Country | US
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Telephone | 575-218-3541
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Fax |
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Provider Business Mailing Address
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Address Line | 3812 BENJAMIN DAVIS DR
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City | CLOVIS
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State | NM
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Zip | 88101-2721
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ADAM STRONG BUNKER
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Credential | DMD
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Telephone | 575-218-3541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DD3014
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License Number State | NM
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