# LEA COUNTY DENTAL

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

## Provider details

- **NPI number:** 1679931356
- **Authorized official:** DR. NISHANTH REDDY PUCHALAPALLI DDS (DENTIST)
- **Authorized official phone:** (408) 306-8365

## Contact information

- **Practice address:** 701 N MAIN AVE, LOVINGTON, NM 88260-3417
- **Practice address phone:** (408) 306-8365
- **Mailing address:** 701 N MAIN AVE, LOVINGTON, NM 88260-3417
- **Mailing address phone:** (408) 306-8365

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | NULL | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | — | — |

## Other

- **Enumeration date:** 02/09/2016
- **Last updated:** 02/12/2016