6588 East Main Farmington LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

6588 EAST MAIN FARMINGTON LLC

Practice address

6588 E Main St
Farmington, NM 87402-5122

Phone

(505) 326-6800

Fax

(505) 326-6820

NPI assigned

Aug 24, 2020

Organization subpart

No

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

Authorized official

Name

Pam Draper

Title

Office Manager

Phone

(505) 326-6800

Specialties & licenses 1

Addresses

Other names 1

• Sundance Dental of Country Club Doing business as

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

{
    "created_epoch": "1598227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598227200000",
    "number": "1154934818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6588 E MAIN ST",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874025122",
            "telephone_number": "505-326-6800",
            "fax_number": "505-326-6820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6588 E MAIN ST",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874025122",
            "telephone_number": "505-326-6800",
            "fax_number": "505-326-6820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "6588 EAST MAIN FARMINGTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-24",
        "last_updated": "2020-08-24",
        "certification_date": "2020-08-24",
        "status": "A",
        "authorized_official_last_name": "DRAPER",
        "authorized_official_first_name": "PAM",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "505-326-6800"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sundance Dental of Country Club",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2020; 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.