# PROFESSIONAL DENTAL CARE OF SOUTHERN NM I PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROFESSIONAL DENTAL CARE PLLC
- **Other names:** Peter Thompson, DDS
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1306415955
- **Legal business name:** PROFESSIONAL DENTAL CARE PLLC
- **Authorized official:** CARY LACOUTURE DDS (CLINICAL DIRECTOR)
- **Authorized official phone:** (303) 521-5701

## Contact information

- **Practice address:** 123 W 2ND ST, PORTALES, NM 88130-6201
- **Practice address phone:** (575) 448-8863
- **Mailing address:** 123 W 2ND ST, PORTALES, NM 88130-6201
- **Mailing address phone:** (575) 448-8863

## Taxonomy

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

## Other

- **Enumeration date:** 06/18/2021
- **Last updated:** 06/18/2021