| Kenneth W Childress Dds Pc | |
|
721 Mechem Dr Sierra Mall #5 Ruidoso NM 88345-6911 | |
| (575) 257-0246 | |
| Not Available |
| Full Name | Kenneth W Childress Dds Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 721 Mechem Dr, Ruidoso, New Mexico |
| Authorized Official Name and Position | Kenneth Childress (PRESIDENT) |
| Authorized Official Contact | 7196717369 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth W Childress Dds Pc 721 Mechem Dr Sierra Mall #5 Ruidoso NM 88345-6911 Ph: () - | Kenneth W Childress Dds Pc 721 Mechem Dr Sierra Mall #5 Ruidoso NM 88345-6911 Ph: (575) 257-0246 |
| NPI Number | 1982913935 |
|---|---|
| Provider Enumeration Date | 09/24/2010 |
| Last Update Date | 03/14/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982913935 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2704 (New Mexico) | Primary |
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