MEDICARE: DARREN HALTOM SPECIALTY PARTNERS OF NM II, LLC

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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1528920212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DARREN HALTOM SPECIALTY PARTNERS OF NM II, LLC

Provider Business Mailing Address
First Line	:	8300 CARMEL AVE NE STE 602
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87122-3150
Country	:	US
Telephone Number	:	505-878-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1209 BONITA ST STE A
Second Line	:
City	:	GRANTS
State	:	NM
Zip	:	87020-2103
Country	:	US
Telephone Number	:	505-285-3443
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF RCM
Name	:	KRYSTAL RICHARDSON
Credential	:
Telephone Number	:	214-934-7995

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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