# NEW MEXICO DENTAL INSTITUTE INC

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

## Provider details

- **NPI number:** 1366101305
- **Authorized official:** DR. GEORGE HANNA (OWNER)
- **Authorized official phone:** (575) 993-5032

## Contact information

- **Practice address:** 204B NEEL AVE, SOCORRO, NM 87801-4649
- **Practice address phone:** (575) 993-5032
- **Practice address fax:** (505) 226-9697
- **Mailing address:** 204B NEEL AVE, SOCORRO, NM 87801-4649
- **Mailing address phone:** (575) 993-5032
- **Mailing address fax:** (505) 226-9697

## Taxonomy

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

## Other

- **Enumeration date:** 12/16/2021
- **Last updated:** 12/16/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 89223829 | — | NM |