1285070227 NPI number — UNITED ORTHODONTICS OF LAS CRUCES PLLC

Table of content: (NPI 1285070227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285070227 NPI number — UNITED ORTHODONTICS OF LAS CRUCES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED ORTHODONTICS OF LAS CRUCES PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SMILELIFE ORTHODONTICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285070227
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 N TELSHOR BLVD
Provider Second Line Business Mailing Address:
STE E
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88011-8277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-521-0900
Provider Business Mailing Address Fax Number:
575-522-0154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17503 LA CANTERA PKWY
Provider Second Line Business Practice Location Address:
STE104-496
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78257-8207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-561-2400
Provider Business Practice Location Address Fax Number:
210-561-2400
Provider Enumeration Date:
05/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
361-442-4902

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  23677 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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