Organization
SUMMIT FAMILY DENTAL OF FARMINGTON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA HODGES (OPERATIONS DIRECTOR)
(505) 787-2965
Entity
Organization
Contact information
Practice address
800 E 30TH ST BLDG 3, FARMINGTON, NM 87401-9407
(505) 327-9161
Mailing address
6588 E MAIN STREET, FARMINGTON, NM 87402-5122
(505) 326-6800
(505) 326-6820
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
CS00213848
NM
Other
Enumeration date
02/03/2012
Last updated
10/15/2020
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