| Southern New Mexico Orthodontics Llc | |
|
1310 E Pine St Ste B Deming NM 88030-7003 | |
| (575) 544-9999 | |
| (575) 546-1070 |
| Full Name | Southern New Mexico Orthodontics Llc |
|---|---|
| Speciality | Dentist |
| Location | 1310 E Pine St Ste B, Deming, New Mexico |
| Authorized Official Name and Position | Ebonie Marie Bogdan (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 5058929010 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern New Mexico Orthodontics Llc 1310 E Pine St Ste B Deming NM 88030-7003 Ph: (575) 544-9999 | Southern New Mexico Orthodontics Llc 1310 E Pine St Ste B Deming NM 88030-7003 Ph: (575) 544-9999 |
| NPI Number | 1285091181 |
|---|---|
| Provider Enumeration Date | 01/22/2016 |
| Last Update Date | 01/22/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285091181 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DD4435 (New Mexico) | Primary |
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