# SUMMIT FAMILY DENTAL OF FARMINGTON, LLC

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

## Provider details

- **NPI number:** 1427320654
- **Authorized official:** LISA HODGES (OPERATIONS DIRECTOR)
- **Authorized official phone:** (505) 787-2965

## Contact information

- **Practice address:** 800 E 30TH ST BLDG 3, FARMINGTON, NM 87401-9407
- **Practice address phone:** (505) 327-9161
- **Mailing address:** 6588 E MAIN STREET, 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 | CS00213848 | NM | Yes |

## Other

- **Enumeration date:** 02/03/2012
- **Last updated:** 10/15/2020