Four Corners Family Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

FOUR CORNERS FAMILY DENTAL LLC

Practice address

383 Canyonview Dr
Farmington, NM 87401-8629

Phone

(505) 564-4470

NPI assigned

Mar 8, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Tyler Anthony Mann, D.D.S.

Title

Dentist

Phone

(505) 564-4470

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1268006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268006400000",
    "number": "1669795456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3501 N BUTLER AVE STE 114",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874016429",
            "telephone_number": "505-564-4470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "383 CANYONVIEW DR",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874018629",
            "telephone_number": "505-564-4470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR CORNERS FAMILY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-08",
        "last_updated": "2010-03-08",
        "status": "A",
        "authorized_official_last_name": "MANN",
        "authorized_official_first_name": "TYLER",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "505-564-4470",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Farmington, NM
• Providers in Farmington, 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 Mar 8, 2010; 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.