Professional Dental Care of Northern New Mexico III

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PROFESSIONAL DENTAL CARE OF NORTHERN NEW MEXICO III

Practice address

2500 7TH St Ste H
Las Vegas, NM 87701-4947

Phone

(505) 718-9156

NPI assigned

Jan 12, 2021

Organization subpart

Yes

Parent organization

SSUN HEALTH, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cary Lacouture, DDS

Title

Clinical Manager

Phone

(303) 521-5701

Specialties & licenses 1

Addresses

Other names 1

• Divine Dental Center Doing business as

Part of

Ssun Health LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Ssun Health, LLC

  • General Practice Dentistry
  • Santa Fe, NM
  • NPI 1811527872
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610409600000",
    "number": "1033708235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10233 S PARKER RD STE 107",
            "city": "PARKER",
            "state": "CO",
            "postal_code": "801349314",
            "telephone_number": "303-521-5701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 7TH ST STE H",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877014947",
            "telephone_number": "505-718-9156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL CARE OF NORTHERN NEW MEXICO III",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SSUN HEALTH, LLC",
        "enumeration_date": "2021-01-12",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A",
        "authorized_official_last_name": "LACOUTURE",
        "authorized_official_first_name": "CARY",
        "authorized_official_title_or_position": "CLINICAL MANAGER",
        "authorized_official_telephone_number": "303-521-5701",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Divine Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Yvette R Pomponi, LAT, ATC
• Juan Portley
• Tristen Price, LMSW
• Wendy Price, PSY.D.
• Matthew D. Probst, PA-C
• Amanda Prue
• Quality Care, LLC.
• Michael Quintana
• Rainbow Road Therapies, Inc.
• Chaya R Rakofsky, LMT

• General Practice Dentistry in Las Vegas, NM
• Providers in Las Vegas, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.