Patricia B Valdivia, DDS
Individual provider Active NPI General Practice Dentistry · Grants, NM
NPI 1891776225 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1891776225
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DD1637 (NM)
- Practice address
- 1209 Bonita St
Grants, NM 87020-2103 - Phone
- (505) 876-4034
- Fax
- (505) 876-4036
- NPI assigned
- Nov 11, 2005
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD1637 | NM | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Derrick Baca DDS LLC | General Practice | Past | Accepting new patients |
| Patricia B. Valdivia D.D.S.,P.C. | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DD1637 | NM | Yes |
Addresses
Primary practice location
1209 Bonita St
Grants, NM 87020-2103
Mailing address
1209 Bonita St
Grants, NM 87020-2103
Phone (505) 285-6937
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89292 | Medicaid | NM | |
| 837938 | Other | NM | UNITED CONCOORDIA |
| 6583 | Other | NM | DORAL DENTAL |
Other providers in Grants, NM
- Total Options Equipment Providers, Inc.
- Town of Grants
- Tribeaid Inc
- Annessa Valdez Simpkins
- Arnold W Valdivia
- Tearza Valencia
- Robert Phillip Velarde
- Amber Nicole Velez
- Michael J Venable
- Janell Marie Villalobos
All providers in Grants, 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 Jul 8, 2007. 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.