Organization
ANIMAS PEDIATRIC DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAWRENCE SUAZO D.D.S (OWNER)
(505) 599-9359
Entity
Organization
Contact information
Practice address
2650 E PINON FRONTAGE RD. BLDG. 200, FARMINGTON, NM 87402-5061
(505) 599-9359
(505) 599-8177
Mailing address
2650 E PINON FRONTAGE RD. BLDG. 200, FARMINGTON, NM 87402-5061
(505) 599-9359
(505) 599-8177
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D1997
NM
1223P0221X
Pediatric Dentistry
DD1997
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00076517
—
NM
Enumeration date
10/10/2006
Last updated
11/26/2014
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