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General NPI Number Information
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NPI Number | 1972928067
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Entity Type | Organization
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Legal Business Name | YUCCA DENTAL CENTER, P.C.
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Dates
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Enumeration Date | 02/26/2014
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Last Update Date | 02/26/2014
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Provider Practice Location Address
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Address Line | 606 N 13TH ST
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City | ARTESIA
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State | NM
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Zip | 88210-1165
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Country | US
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Telephone | 248-930-9962
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Fax |
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Provider Business Mailing Address
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Address Line | 606 N 13TH ST
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City | ARTESIA
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State | NM
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Zip | 88210-1165
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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 | CEO
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Name | DR. MARKO FARION
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Credential | D.D.S.
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Telephone | 248-930-9962
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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 | DD3636
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License Number State | NM
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