Organization
NEW MEXICO DENTAL CLINICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE HANNA (OWNER)
(505) 273-3220
Entity
Organization
Contact information
Practice address
1594 SARA RD SE STE C, RIO RANCHO, NM 87124
(866) 851-6236
Mailing address
1594 SARA RD SE STE C, RIO RANCHO, NM 87124-1860
(866) 851-6236
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DD4651
NM
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD4651
DENTAL LICENSE
NM
Enumeration date
04/19/2018
Last updated
08/22/2022
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