Individual
DR. MARK A NIEMIEC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1399 WEIMER RD, SUITE 800, TAOS, NM 87571-6340
(505) 758-9777
(505) 758-9413
Mailing address
1399 WEIMER RD, SUITE 800, TAOS, NM 87571-6340
(505) 758-9777
(505) 758-9413
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD1797
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105266
—
NM
01
—
976951
UNITED CONCORDIA PROVIDER
NM
Enumeration date
03/07/2007
Last updated
07/09/2007
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