# BECKLAND DENTAL KIDS OF FARMINGTON LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104377811
- **Authorized official:** LISA HODGES (OPERATIONS DIRECTOR)
- **Authorized official phone:** (505) 787-2965

## Contact information

- **Practice address:** 3903 BECKLAND DR, FARMINGTON, NM 87402-4701
- **Practice address phone:** (505) 436-2735
- **Practice address fax:** (505) 436-2735
- **Mailing address:** 3909 BECKLAND DR., FARMINGTON, NM 87402
- **Mailing address phone:** (505) 436-2735
- **Mailing address fax:** (505) 436-2736

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DD2872 | NM | — |
| 1223G0001X | General Practice Dentistry | DD3385 | NM | Yes |

## Other

- **Enumeration date:** 10/18/2016
- **Last updated:** 10/15/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 99183064 | — | NM |