NPIMap

Organization Active NPI

Small Fry Dentistry PC

  • Dentist
  • Gallup, NM
National Provider Identifier
1639361371
Registry record updated Aug 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DD2150 Issued in NM
Legal business name
SMALL FRY DENTISTRY PC
Practice address
1401 Linda Dr
Gallup, NM 87301-5615
Phone
(505) 870-6128
NPI assigned
Aug 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2007

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

Authorized official

Name
Dr. Eduardo Valda, DDSNPI 1174509582
Title
Owner
Phone
(505) 870-6128

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DD2150 NM Primary

Addresses

Primary practice location

1401 Linda Dr
Gallup, NM 87301-5615

Mailing address

1401 Linda Dr
Gallup, NM 87301-5615

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1187222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187222400000",
    "number": "1639361371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 LINDA DR",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 LINDA DR",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015615",
            "telephone_number": "505-870-6128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMALL FRY DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-16",
        "last_updated": "2007-08-16",
        "status": "A",
        "authorized_official_last_name": "VALDA",
        "authorized_official_first_name": "EDUARDO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-870-6128",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD2150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gallup, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2007; 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.