Sundance Dental Care of Grants

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2966 Issued in NM

Legal business name

SUNDANCE DENTAL CARE OF GRANTS

Practice address

920 Lobo Canyon Rd
Grants, NM 87020-2173

Phone

(505) 722-4422

Fax

(505) 722-2060

NPI assigned

Jan 5, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Michael D King, DMD

Title

Owner

Phone

(505) 722-4422

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1451952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451952000000",
    "number": "1467818518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 S SECOND ST",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015816",
            "telephone_number": "505-722-4422",
            "fax_number": "505-722-2060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 LOBO CANYON RD",
            "city": "GRANTS",
            "state": "NM",
            "postal_code": "870202173",
            "telephone_number": "505-722-4422",
            "fax_number": "505-722-2060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNDANCE DENTAL CARE OF GRANTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-05",
        "last_updated": "2016-01-05",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-722-4422",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "2966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "97524239",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Daniel Soulsby, DC
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• Sparkling Smiles Dental
• Jessica Kyer Stelly, RN
• Sandra Michelle Suazo, CHW
• Jennifer Swank
• Amber Joy Tenorio
• The Evangelical Lutheran Good Samaritan Society
• Thomas J Habiger
• Nicole Thomas, CSW

• General Practice Dentistry in Grants, NM
• Providers in Grants, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2016; 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.