Chama Valley Dental Care
Organization Active NPI Dentist · Chama, NM
NPI 1386918399 · NPPES record last updated Mar 8, 2012
Key facts
- NPI
- 1386918399
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- License
- DD1550 (NM)
- Legal business name
- CHAMA VALLEY DENTAL CARE
- Practice address
- 451 Maple Ave.
Chama, NM 87520 - Phone
- (575) 756-2901
- NPI assigned
- Mar 8, 2012
- Organization subpart
- No
Authorized official
- Name
- Grant Allen
- Title
- Dentist
- Phone
- (575) 756-2901
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | DD1550 | NM | Yes |
Addresses
Primary practice location
451 Maple Ave.
Chama, NM 87520
Mailing address
PO Box 276
Chama, NM 87520-0276
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00085538 | Medicaid | NM |
Other providers in Chama, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.