Individual
MELINDA HALL HACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
710 AVE E, CARRIZOZO, NM 88301-0008
(575) 648-2839
(505) 648-4113
Mailing address
PO BOX 26666, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD2688
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
NM
Enumeration date
07/11/2006
Last updated
09/28/2021
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