Organization
BECKLAND DENTAL KIDS OF FARMINGTON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA HODGES (OPERATIONS DIRECTOR)
(505) 787-2965
Entity
Organization
Contact information
Practice address
3903 BECKLAND DR, FARMINGTON, NM 87402-4701
(505) 436-2735
(505) 436-2735
Mailing address
3909 BECKLAND DR., FARMINGTON, NM 87402
(505) 436-2735
(505) 436-2736
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DD2872
NM
1223G0001X
General Practice Dentistry
Primary
DD3385
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
99183064
—
NM
Enumeration date
10/18/2016
Last updated
10/15/2020
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