# SANTA FE MODERN DENTISTRY AND ORTHODONTICS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Santa Fe Modern Dentistry and Orthodontics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689950008
- **Authorized official:** DR. KELLEY HOLLINGSWORTH RYALS DDS (OWNER DOCTOR)
- **Authorized official phone:** (505) 986-8000

## Contact information

- **Practice address:** 3569 ZAFARANO BOULEVARD, SANTA FE, NM 87507
- **Practice address phone:** (505) 986-8000
- **Practice address fax:** (505) 982-0374
- **Mailing address:** 17000 RED HILL AVE, IRVINE, CA 92614-5626
- **Mailing address phone:** (714) 845-8890
- **Mailing address fax:** (949) 474-1495

## Taxonomy

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

## Other

- **Enumeration date:** 10/31/2011
- **Last updated:** 12/31/2013