Organization
NORTHERN NM CENTER FOR COSMETIC DENTISTRY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLIE A HARRIS DDS (PRESIDENT)
(575) 751-9661
Entity
Organization
Contact information
Practice address
1337 GUSDORF RD, SUITE A, TAOS, NM 87571-6294
(575) 751-9661
(575) 751-9689
Mailing address
1337 GUSDORF RD, SUITE A, TAOS, NM 87571-6294
(575) 751-9661
(575) 751-9689
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD1953
NM
1223E0200X
Endodontics
DD3454
NM
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DD1576
NM
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DD4507
NM
Other
Enumeration date
04/05/2017
Last updated
05/04/2017
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