# 6588 EAST MAIN FARMINGTON LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sundance Dental of Country Club
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154934818
- **Authorized official:** PAM DRAPER (OFFICE MANAGER)
- **Authorized official phone:** (505) 326-6800

## Contact information

- **Practice address:** 6588 E MAIN ST, FARMINGTON, NM 87402-5122
- **Practice address phone:** (505) 326-6800
- **Practice address fax:** (505) 326-6820
- **Mailing address:** 6588 E MAIN ST, FARMINGTON, NM 87402-5122
- **Mailing address phone:** (505) 326-6800
- **Mailing address fax:** (505) 326-6820

## Taxonomy

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

## Other

- **Enumeration date:** 08/24/2020
- **Last updated:** 08/24/2020