# MAUPIN DENTAL, LLC

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

## Provider details

- **NPI number:** 1679867899
- **Authorized official:** MRS. JANET RICHARDSON (OFFICE MANAGER)
- **Authorized official phone:** (575) 627-0141

## Contact information

- **Practice address:** 114 E 4TH ST STE 100, ROSWELL, NM 88201-6283
- **Practice address phone:** (575) 627-0141
- **Practice address fax:** (575) 625-6713
- **Mailing address:** 114 E 4TH ST STE 100, ROSWELL, NM 88201-6283
- **Mailing address phone:** (575) 627-0141
- **Mailing address fax:** (575) 625-6713

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DD2615 | NM | Yes |

## Other

- **Enumeration date:** 06/06/2011
- **Last updated:** 06/06/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 13687735 | — | NM |