Organization
CHILDRENS DENTAL CLINIC OF RUIDOSO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MACK ALLEN MCGUINNESS DDS (PRESIDENT)
(505) 257-0246
Entity
Organization
Contact information
Practice address
721 MECHEM SIERRA MALL #5, RUIDOSO, NM 88345-6911
(505) 257-0246
(505) 257-0249
Mailing address
721 MECHEM SIERRA MALL #5, RUIDOSO, NM 88345-6911
(505) 257-0246
(505) 257-0249
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DD1984
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008C53
BC/BS OF NM
NM
05
—
71823
—
NM
Enumeration date
11/21/2006
Last updated
09/05/2007
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