Organization
SOUTHERN NEW MEXICO ORTHODONTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBONIE MARIE BOGDAN (CREDENTIALING SPECIALIST)
(505) 892-9010
Entity
Organization
Contact information
Practice address
1310 E PINE ST STE B, DEMING, NM 88030-7003
(575) 544-9999
(575) 546-1070
Mailing address
1310 E PINE ST STE B, DEMING, NM 88030-7003
(575) 544-9999
(575) 546-1070
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD4435
NM
Other
Enumeration date
01/22/2016
Last updated
01/22/2016
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