| Embudo Dental Center Llc | |
|
1102 State Highway 68 Embudo NM 87531-0037 | |
| (505) 579-4680 | |
| (505) 579-4074 |
| Full Name | Embudo Dental Center Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1102 State Highway 68, Embudo, New Mexico |
| Authorized Official Name and Position | Kellie A Harris (OWNER/DENTIST) |
| Authorized Official Contact | 5055794680 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Embudo Dental Center Llc Po Box 37 1102 State Highway 68 Embudo NM 87531-0037 Ph: (505) 579-4680 | Embudo Dental Center Llc 1102 State Highway 68 Embudo NM 87531-0037 Ph: (505) 579-4680 |
| NPI Number | 1679017453 |
|---|---|
| Provider Enumeration Date | 12/13/2016 |
| Last Update Date | 12/13/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679017453 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DD1074 (New Mexico) | Secondary |
| 261QD0000X | Clinic/center - Dental | DD1953 (New Mexico) | Primary |