Individual
KYRA VANDEN BROECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
800 E 30TH ST BLDG 3, FARMINGTON, NM 87401-9407
(505) 327-9162
Mailing address
3703 HIGHLAND VIEW DR, FARMINGTON, NM 87402-8328
(505) 801-8154
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD5322
NM
Other
Enumeration date
09/07/2020
Last updated
09/07/2020
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