Embudo Dental Center LLC
Organization Active NPI Dental Clinic/Center · Embudo, NM
NPI 1679017453 · NPPES record last updated Dec 13, 2016
Key facts
- NPI
- 1679017453
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dental Clinic/Center 261QD0000X
- License
- DD1953 (NM)
- Legal business name
- EMBUDO DENTAL CENTER LLC
- Practice address
- 1102 State Highway 68
Embudo, NM 87531-0037 - Phone
- (505) 579-4680
- Fax
- (505) 579-4074
- NPI assigned
- Dec 13, 2016
- Organization subpart
- No
Authorized official
- Name
- Kellie A Harris, DDS
- Title
- Owner/Dentist
- Phone
- (505) 579-4680
Practitioners 2
-
Kayci M Harris, DMD
-
Richard D Padberg, DMD
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | DD1953 | NM | Yes |
| Dental Clinic/Center | 261QD0000X | DD1074 | NM |
Addresses
Primary practice location
1102 State Highway 68
Embudo, NM 87531-0037
Mailing address
PO Box 37
1102 State Highway 68
Embudo, NM 87531-0037
Phone (505) 579-4680
Other providers in Embudo, NM
- Sumeyra Baskoy
- El Centro Family Health
- Kayci M Harris
- Kaycee Hinckley
- James Martin
- Northern NM Vocational Training
- Richard D Padberg
All providers in Embudo, NM · Dental Clinic/Center 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 Dec 13, 2016. 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.