# CHILDREN'S DENTAL AT SONOMA

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

## Provider details

- **NPI number:** 1972936235
- **Authorized official:** CORY THOMPSON D.M.D. (OWNER)
- **Authorized official phone:** (575) 382-2105

## Contact information

- **Practice address:** 3340 RINCONADA BLVD, SUITE 2B, LAS CRUCES, NM 88011
- **Practice address phone:** (575) 382-2105
- **Mailing address:** 3340 RINCONADA BLVD, SUITE 2B, LAS CRUCES, NM 88011
- **Mailing address phone:** (575) 382-2105

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DD3462 | NM | Yes |

## Other

- **Enumeration date:** 08/09/2013
- **Last updated:** 09/11/2014