Myrna L Policarpio, DDS
Individual provider Active NPI General Practice Dentistry · T Or C, NM
NPI 1386810331 · NPPES record last updated Aug 24, 2020
Key facts
- NPI
- 1386810331
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DD2984 (NM)
- Practice address
- 1960 N Date St
T Or C, NM 87901-3701 - Phone
- (575) 894-7662
- Fax
- (575) 894-7930
- NPI assigned
- Apr 30, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200803000243 | NM | Order and Referring Only - Dentist |
2769807163 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ben Archer Health Center | Past | Accepting new patients | |
| Ben Archer Health Center | Past | Accepting new patients | |
| Ben Archer Health Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DD2984 | NM | Yes |
Addresses
Primary practice location
1960 N Date St
T Or C, NM 87901-3701
Mailing address
PO Box 370
Hatch, NM 87937-0370
Phone (575) 267-3280
Other providers in T Or C, NM
- Richard R. Mireles
- Annette A Miyamoto
- Carol Morrell
- Vishna Peoples
- Matthew Myers Peters
- Ashleigh Pratt
- Carol Renninger
- Darlene Rouse
- Rustic Health LLC
- Mary Rebecca Rylance
All providers in T Or C, NM · General Practice Dentistry in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 24, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.