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Organization
EASTERN NEW MEXICO ENDODONTICS, PC
Active
Organization
EASTERN NEW MEXICO ENDODONTICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHAD RICKY SOUTHARD FACHE, FHFMA (ADMINISTRATOR)
(806) 797-4455
Entity
Organization
Contact information
Practice address
2000 W 21ST ST, SUITE L1, CLOVIS, NM 88101-4087
(575) 762-8000
(575) 763-0418
Mailing address
2000 W 21ST ST, SUITE L1, CLOVIS, NM 88101-4087
(575) 762-8000
(575) 763-0418
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/26/2016
Last updated
08/26/2016
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