Tanya Sue Maestas, DDS
Individual provider Active NPI General Practice Dentistry · Chaparral, NM
NPI 1801448964 · NPPES record last updated Aug 22, 2019
Key facts
- NPI
- 1801448964
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DD5147 (NM)
- Practice address
- 510 E Lisa Dr
Chaparral, NM 88081-7809 - Phone
- (575) 824-0128
- NPI assigned
- Jul 9, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|---|
| I20240826000128 | TX | Practitioner - Dentist | 4587103304 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34700 | TX | MD | Clinical Psychologist |
| DD5147 | NM | MD | General Practice Dentistry |
| 37400 | TX | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ysleta del Sur Pueblo Community Health Center | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DD5147 | NM | Yes |
| General Practice Dentistry | 1223G0001X | 37400 | TX |
Addresses
Primary practice location
510 E Lisa Dr
Chaparral, NM 88081-7809
Mailing address
385 Calle de Alegra Ste a
Las Cruces, NM 88005-3423
Phone (575) 526-1105
Other providers in Chaparral, NM
- La Clinica de Familia, Incorporated
- Jeanette Lara
- Guadalupe Lerma
- Lessons From Horses, Inc.
- Ruth Lozano
- Manabat LLC
- Levin E Manabat
- Javier F Martinez
- Kevin M McGuinness
- Christal Medina
All providers in Chaparral, NM · General Practice Dentistry 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 Aug 22, 2019. 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.