MEDICARE: SANTA FE FAMILY DENTISTRY LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1225427396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA FE FAMILY DENTISTRY LTD

Provider Business Mailing Address
First Line	:	1406 LUISA ST
Second Line	:	STE 1
City	:	SANTA FE
State	:	NM
Zip	:	87505-4347
Country	:	US
Telephone Number	:	505-988-5850
Fax Number	:

Provider Business Practice Location Address
First Line	:	4146 NEUMAN RD
Second Line	:
City	:	SAINT CLAIR
State	:	MI
Zip	:	48079-3234
Country	:	US
Telephone Number	:	810-941-8983
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JARED POPE
Credential	:	DDS
Telephone Number	:	505-988-5850

Provider Enumeration Date	:	01/13/2015
Last Update Date	:	01/13/2015

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