NPIMap

Organization Active NPI

San Juan College

  • Dental Clinic/Center
  • Farmington, NM
National Provider Identifier
1679740013
Registry record updated May 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
DD-2461 Issued in NM
Legal business name
SAN JUAN COLLEGE
Practice address
4601 College Blvd
Dental Clinic
Farmington, NM 87402-4609
Phone
(505) 566-3126
Fax
(505) 566-3790
NPI assigned
May 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2008

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

Authorized official

Name
Dr. Carol Spencer
Title
President
Phone
(505) 566-3209

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X DD-2461 NM Primary

Addresses

Primary practice location

4601 College Blvd
Dental Clinic
Farmington, NM 87402-4609

Mailing address

4601 College Blvd
Farmington, NM 87402-4609
Phone (505) 566-3126

Other identifiers 1

IdentifierTypeStateIssuer
59457538MedicaidNM

National Provider Directory

National Provider Directory
Tax ID family
San Juan College4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1210723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210723200000",
    "number": "1679740013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 COLLEGE BLVD",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874024609",
            "telephone_number": "505-566-3126",
            "fax_number": "505-566-3790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 COLLEGE BLVD",
            "address_2": "DENTAL CLINIC",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874024609",
            "telephone_number": "505-566-3126",
            "fax_number": "505-566-3790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JUAN COLLEGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-14",
        "last_updated": "2008-05-14",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "505-566-3209",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NM",
            "license": "DD-2461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "59457538",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; 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.