1326038563 NPI number — DEMING DENTAL SERVICES, P.A.

Table of content: (NPI 1326038563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326038563 NPI number — DEMING DENTAL SERVICES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEMING DENTAL SERVICES, P.A.
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:
Provider Other Organization Name Type Code:
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:
1326038563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 S GOLD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEMING
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88030-4159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-546-2684
Provider Business Mailing Address Fax Number:
505-546-1106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 S GOLD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEMING
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88030-4159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-546-2684
Provider Business Practice Location Address Fax Number:
505-546-1106
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
O'CONNELL
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRES. CORP.
Authorized Official Telephone Number:
505-546-2684

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  1072 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4908 . This is a "DORAL DENTAL" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 3145509 . This is a "BLUE CROSS OF TENNESSEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 839147 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 008656 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 86546 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com