NPIMap

Organization Active NPI

Socorro Dental LLC

  • Dentist
  • Socorro, NM
National Provider Identifier
1932643038
Registry record updated Aug 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DD4651 Issued in NM
Legal business name
SOCORRO DENTAL LLC
Practice address
204B Neel Ave
Socorro, NM 87801-4649
Phone
(267) 318-6667
NPI assigned
Dec 7, 2016
Last updated
Aug 30, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2022

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

Authorized official

Name
Dr. George HannaNPI 1881755825
Title
Owner
Phone
(575) 993-5032

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Dentist 122300000X DD4651 NM Primary

Addresses

Primary practice location

204B Neel Ave
Socorro, NM 87801-4649

Mailing address

204B Neel Ave
Socorro, NM 87801-4649
Phone (575) 993-5032

Other identifiers 2

IdentifierTypeStateIssuer
1881755825OtherNMNPI
89223829MedicaidNM

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL http://socorrodental.setmore.com/ Direct

National Provider Directory

National Provider Directory

Locations

204B Neel Ave
Socorro, NM 87801
Phone (267) 318-6667

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1481068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661817600000",
    "number": "1932643038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204B NEEL AVE",
            "city": "SOCORRO",
            "state": "NM",
            "postal_code": "878014649",
            "telephone_number": "575-993-5032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204B NEEL AVE",
            "city": "SOCORRO",
            "state": "NM",
            "postal_code": "878014649",
            "telephone_number": "267-318-6667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOCORRO DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-07",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A",
        "authorized_official_last_name": "HANNA",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "575-993-5032",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD4651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1881755825",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89223829",
            "state": "NM"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "http://socorrodental.setmore.com/",
            "affiliation": "N",
            "endpointDescription": "WEBSITE",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "204B Neel Ave",
            "city": "Socorro",
            "state": "NM",
            "country_code": "US",
            "postal_code": "878014649",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Socorro, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; 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.