# EASTERN FAMILY DENTISTRY, LLC

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

## Provider details

- **NPI number:** 1407280530
- **Authorized official:** JESSE MARTIN (PARTNER)
- **Authorized official phone:** (575) 356-8514

## Contact information

- **Practice address:** 1521 W 18TH ST, PORTALES, NM 88130-7018
- **Practice address phone:** (575) 356-8514
- **Mailing address:** 1521 W 18TH ST, PORTALES, NM 88130-7018
- **Mailing address phone:** (575) 356-8514

## Taxonomy

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

## Other

- **Enumeration date:** 08/26/2013
- **Last updated:** 08/26/2013