| Derrick Baca Dds Llc | |
|
1209 Bonita St Grants NM 87020-2103 | |
| (505) 876-4034 | |
| (505) 876-4036 |
| Full Name | Derrick Baca Dds Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1209 Bonita St, Grants, New Mexico |
| Authorized Official Name and Position | Derrick R Baca (GENERAL DENTIST) |
| Authorized Official Contact | 5058764034 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Derrick Baca Dds Llc 1209 Bonita St Grants NM 87020-2103 Ph: (505) 876-4034 | Derrick Baca Dds Llc 1209 Bonita St Grants NM 87020-2103 Ph: (505) 876-4034 |
| NPI Number | 1902214406 |
|---|---|
| Provider Enumeration Date | 07/28/2014 |
| Last Update Date | 07/28/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902214406 | NPI | - | NPPES |
| 93577389 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DD3492 (New Mexico) | Primary |
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