Organization
CLOVIS HOSPITAL DENTISTRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FALON WAISATH D.M.D. (PRESIDENT)
(575) 763-9382
Entity
Organization
Contact information
Practice address
2100 N MARTIN LUTHER KING JR. BLVD, CLOVIS, NM 88101
(575) 763-9382
Mailing address
1552 BOSC CT, CLOVIS, NM 88101-2334
(575) 763-9382
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD3553
NM
Other
Enumeration date
10/30/2012
Last updated
10/30/2012
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