Individual
SELENE MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
385 CALLE DE ALEGRA, BUILDING C, LAS CRUCES, NM 88005-3423
(575) 532-1933
Mailing address
PO BOX 13725, LAS CRUCES, NM 88013-3725
(575) 532-1933
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
3683
NM
Other
Enumeration date
03/19/2015
Last updated
03/19/2015
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