Clovis Hospital Dentistry PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DD3553 Issued in NM

Legal business name

CLOVIS HOSPITAL DENTISTRY PC

Practice address

2100 N Martin Luther King Jr. Blvd
Clovis, NM 88101

Phone

(575) 763-9382

NPI assigned

Oct 30, 2012

Last updated

Oct 30, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Falon Waisath, D.M.D.

Title

President

Phone

(575) 763-9382

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351555200000",
    "number": "1083968077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1552 BOSC CT",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881012334",
            "telephone_number": "575-763-9382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 N MARTIN LUTHER KING JR. BLVD",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "88101",
            "telephone_number": "575-763-9382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLOVIS HOSPITAL DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-30",
        "last_updated": "2012-10-30",
        "status": "A",
        "authorized_official_last_name": "WAISATH",
        "authorized_official_first_name": "FALON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "575-763-9382",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD3553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clovis Family Health Care Center LLC
• Clovis Family Healthcare Center LLC (Encore Express Care)
• Clovis Family Urgent Care LLC (Clovis Family Urgent Care)
• Clovis Healthcare and Rehabilitation Center, LLC (Clovis Healthcare and Rehabilitation Center)
• Clovis Homecare, Inc. (Community Homecare)
• Clovis Medical Associates LLC
• Clovis Municipal Schools
• Clovis Municipal Schools
• Clovis Municipal Schools
• Clovis Orthodontics, PLLC (Sparkman Orthodontics)

• General Practice Dentistry in Clovis, NM
• Providers in Clovis, 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 Oct 30, 2012; 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.