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NPI Code Detail

MEDICARE: SANTA FE COMMUNITY COLLEGE DENTAL CLINIC

MEDICARE: SANTA FE COMMUNITY COLLEGE DENTAL CLINIC
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
11223G0001XGeneral Practice Dentistry

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790953404
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANTA FE COMMUNITY COLLEGE DENTAL CLINIC
Provider Business Mailing Address
First Line : 6401 S RICHARDS AVE
Second Line :
City : SANTA FE
State : NM
Zip : 87508-4887
Country : US
Telephone Number : 505-428-1710
Fax Number : 505-428-1511
Provider Business Practice Location Address
First Line : 6401 S RICHARDS AVE
Second Line :
City : SANTA FE
State : NM
Zip : 87508-4887
Country : US
Telephone Number : 505-428-1710
Fax Number : 505-428-1511
Authorized Official
Title or Position : DENTIST
Name : ALFRED OTERO
Credential : DDS
Telephone Number : 505-428-1710
Provider Enumeration Date : 02/15/2008
Last Update Date : 02/15/2008

Similar Medicare Providers

1841271335 — DR. ALFRED NMN OTERO JR. DDS
Practice Location Address:
6401 S RICHARDS AVE
SANTA FE, NM
87508-4887
Practice Phone: 505-428-1710
Practice Fax: 505-428-1511
1336437672 — LA FAMILIA MEDICAL CENTER
Practice Location Address:
6401 S RICHARDS AVE
SANTA FE, NM
87508-4887
Practice Phone: 505-984-5048
Practice Fax: 505-983-4751
1881979128 — DR. JULIE K ATKINSON DMD
Practice Location Address:
6401 S RICHARDS AVE
SANTA FE, NM
87508-4887
Practice Phone: 505-984-5048
Practice Fax: 505-983-4751
1063773513 — DR. MELISSA FLYNN D.D.S
Practice Location Address:
6401 S RICHARDS AVE
SANTA FE, NM
87508-4887
Practice Phone: 505-982-4425
Practice Fax:
1922511641 — SAMANTHA JEAN DRAPER RDH
Practice Location Address:
6401 S RICHARDS AVE
SANTA FE, NM
87508-4887
Practice Phone: 505-984-5048
Practice Fax:
1801300660 — MRS. HARINI DHARMAGADDA RDH
Practice Location Address:
6401 S RICHARDS AVE
SANTA FE, NM
87508-4887
Practice Phone: 505-984-5048
Practice Fax:

Directions to “SANTA FE COMMUNITY COLLEGE DENTAL CLINIC ” Practice Location

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