Organization
ORTHODONTICS LC3, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH C COOMBS D.D.S. (OWNER)
(575) 521-0900
Entity
Organization
Contact information
Practice address
920 N TELSHOR BLVD, LAS CRUCES, NM 88011-8277
(575) 521-0900
Mailing address
920 N TELSHOR BLVD, LAS CRUCES, NM 88011-8277
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD4079
NM DENTAL LICENSE
NM
Enumeration date
03/17/2021
Last updated
03/17/2021
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