Derrick Baca DDS LLC
Organization Active NPI General Practice Dentistry · Grants, NM
NPI 1902214406 · NPPES record last updated Jul 28, 2014
Key facts
- NPI
- 1902214406
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DD3492 (NM)
- Legal business name
- DERRICK BACA DDS LLC
- Practice address
- 1209 Bonita St
Grants, NM 87020-2103 - Phone
- (505) 876-4034
- Fax
- (505) 876-4036
- NPI assigned
- Jul 28, 2014
- Organization subpart
- No
Authorized official
- Name
- Dr. Derrick R Baca, DDS
- Title
- General Dentist
- Phone
- (505) 876-4034
Practitioners 3
-
Robin Simon Berrin, D.M.D.
-
Marcellus Gladney, D.M.D.
-
Patricia B Valdivia, DDS
National Provider Directory
Locations
1209 Bonita St
Grants, NM 87020
Phone (505) 876-4034
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | DD3492 | NM | Yes |
Addresses
Primary practice location
1209 Bonita St
Grants, NM 87020-2103
Mailing address
1209 Bonita St
Grants, NM 87020-2103
Phone (505) 876-4034
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 93577389 | Medicaid | NM |
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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 28, 2014. 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.