# PROFESSIONAL DENTAL CARE OF NORTHERN NEW MEXICO III

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SSUN HEALTH, LLC
- **Other names:** Divine Dental Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1033708235
- **Legal business name:** SSUN HEALTH, LLC
- **Authorized official:** CARY LACOUTURE DDS (CLINICAL MANAGER)
- **Authorized official phone:** (303) 521-5701

## Contact information

- **Practice address:** 2500 7TH ST STE H, LAS VEGAS, NM 87701-4947
- **Practice address phone:** (505) 718-9156
- **Mailing address:** 10233 S PARKER RD STE 107, PARKER, CO 80134-9314
- **Mailing address phone:** (303) 521-5701

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 01/12/2021
- **Last updated:** 01/12/2021