Individual
DR. DAVINA ROSE DETRIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2 CALLE MEDICO STE 3, SANTA FE, NM 87505-4785
(505) 303-1974
Mailing address
6835 GUADALUPE TRL NW, LOS RANCHOS, NM 87107-6205
(303) 519-3454
(303) 519-3454
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD3923
NM
Other
Enumeration date
07/19/2013
Last updated
02/10/2024
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