Individual
DR. DERRICK RAY BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5608 ZUNI RD SE, ALBUQUERQUE, NM 87108-2926
(505) 262-6547
Mailing address
5608 ZUNI RD SE, ALBUQUERQUE, NM 87108-2926
(505) 262-6547
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
DD3492
NM
Other
Enumeration date
08/15/2011
Last updated
08/15/2011
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