NPIMap

Organization Active NPI

Animas Pediatric Dental Group

  • Pediatric Dentistry
  • Farmington, NM
National Provider Identifier
1295823177
Registry record updated Nov 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
D1997 Issued in NM
Legal business name
ANIMAS PEDIATRIC DENTAL GROUP
Practice address
2650 E Pinon Frontage Rd. BLDG. 200
Farmington, NM 87402-5061
Phone
(505) 599-9359
Fax
(505) 599-8177
NPI assigned
Oct 10, 2006
Last updated
Nov 26, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2014

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

Authorized official

Name
Lawrence Suazo, D.D.SNPI 1760443998
Title
Owner
Phone
(505) 599-9359

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X DD1997 NM
Pediatric Dentistry 1223P0221X D1997 NM Primary

Addresses

Primary practice location

2650 E Pinon Frontage Rd. BLDG. 200
Farmington, NM 87402-5061

Mailing address

2650 E Pinon Frontage Rd. BLDG. 200
Farmington, NM 87402-5061
Phone (505) 599-9359

Other identifiers 1

IdentifierTypeStateIssuer
00076517MedicaidNM

National Provider Directory

National Provider Directory

Locations

2650 E Pinon Frontage Rd
Bldg 200
Farmington, NM 87402
Phone (505) 599-9359

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": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416960000000",
    "number": "1295823177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 E PINON FRONTAGE RD. BLDG. 200",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874025061",
            "telephone_number": "505-599-9359",
            "fax_number": "505-599-8177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 E PINON FRONTAGE RD. BLDG. 200",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874025061",
            "telephone_number": "505-599-9359",
            "fax_number": "505-599-8177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANIMAS PEDIATRIC DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2014-11-26",
        "status": "A",
        "authorized_official_last_name": "SUAZO",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-599-9359",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NM",
            "license": "DD1997",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NM",
            "license": "D1997",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00076517",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2014; 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.