NPIMap

Organization Active NPI

Northern NM Center for Cosmetic Dentistry Inc

  • Dentist
  • Taos, NM
National Provider Identifier
1184157315
Registry record updated May 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DD1953 Issued in NM
Legal business name
NORTHERN NM CENTER FOR COSMETIC DENTISTRY INC
Practice address
1337 Gusdorf Rd
Suite a
Taos, NM 87571-6294
Phone
(575) 751-9661
Fax
(575) 751-9689
NPI assigned
Apr 5, 2017
Last updated
May 4, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2017

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

Authorized official

Name
Dr. Kellie A Harris, DDSNPI 1144252818
Title
President
Phone
(575) 751-9661

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DD1953 NM Primary
Endodontics 1223E0200X DD3454 NM
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DD1576 NM
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DD4507 NM

Addresses

Primary practice location

1337 Gusdorf Rd
Suite a
Taos, NM 87571-6294

Mailing address

1337 Gusdorf Rd
Suite a
Taos, NM 87571-6294
Phone (575) 751-9661

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1491350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493856000000",
    "number": "1184157315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1337 GUSDORF RD",
            "address_2": "SUITE A",
            "city": "TAOS",
            "state": "NM",
            "postal_code": "875716294",
            "telephone_number": "575-751-9661",
            "fax_number": "575-751-9689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1337 GUSDORF RD",
            "address_2": "SUITE A",
            "city": "TAOS",
            "state": "NM",
            "postal_code": "875716294",
            "telephone_number": "575-751-9661",
            "fax_number": "575-751-9689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN NM CENTER FOR COSMETIC DENTISTRY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-05",
        "last_updated": "2017-05-04",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "KELLIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "575-751-9661",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD1953",
            "primary": true
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NM",
            "license": "DD3454",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NM",
            "license": "DD1576",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NM",
            "license": "DD4507",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Taos, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2017; 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.