Jenna Lotz, DMD
Individual provider Active NPI Dentist · Dulce, NM
NPI 1801203906 · NPPES record last updated Nov 7, 2023
Key facts
- NPI
- 1801203906
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DD4127 (NM)
- Practice address
- 500 N Mundo Dr
Dulce, NM 87528-5176 - Phone
- (575) 759-3291
- Fax
- (575) 759-3651
- NPI assigned
- Jul 21, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231222001597 | TX | Practitioner - Dentist | 2062733256 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD4127 | NM | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jicarilla IHS Pharmacy | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DD4127 | NM | Yes |
Addresses
Primary practice location
500 N Mundo Dr
Dulce, NM 87528-5176
Mailing address
PO Box 187
Dulce, NM 87528-0187
Phone (575) 759-3291
Other names
- Jenna Painter
Other providers in Dulce, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.