| Summit Family Dental Of Kirtland, Llc | |
|
#3 Cr 6523 Kirtland NM 87417 | |
| (505) 598-6800 | |
| (505) 598-6830 |
| Full Name | Summit Family Dental Of Kirtland, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | #3 Cr 6523, Kirtland, New Mexico |
| Authorized Official Name and Position | Cody B Coleman (OWNER) |
| Authorized Official Contact | 5055986800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Summit Family Dental Of Kirtland, Llc #3 Cr 6523 Kirtland NM 87417 Ph: (505) 598-6800 | Summit Family Dental Of Kirtland, Llc #3 Cr 6523 Kirtland NM 87417 Ph: (505) 598-6800 |
| NPI Number | 1710215439 |
|---|---|
| Provider Enumeration Date | 11/19/2009 |
| Last Update Date | 09/30/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710215439 | NPI | - | NPPES |
| 99183064 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DD2872 (New Mexico) | Primary |