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Organization
DENTAL ASSOCIATES PA
Active
Organization
DENTAL ASSOCIATES PA
Active
Other names
Dental Associates PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID A. SUDIMACK D.D.S. (PRESIDENT)
(575) 522-7320
Entity
Organization
Contact information
Practice address
2205 S SOLANO DR, LAS CRUCES, NM 88001
(505) 522-7320
(505) 522-6395
Mailing address
2205 S SOLANO DR, LAS CRUCES, NM 88001
(505) 522-7320
(505) 522-6395
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
NM1518
NM
1223G0001X
General Practice Dentistry
Primary
NM2258
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
806920
UNITED CONCORDIA INS
—
01
—
8403
BLUE CROSS BLUE SHIELD
NM
Enumeration date
09/06/2006
Last updated
11/08/2012
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