Organization
EMBUDO DENTAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLIE A HARRIS DDS (OWNER/DENTIST)
(505) 579-4680
Entity
Organization
Contact information
Practice address
1102 STATE HIGHWAY 68, EMBUDO, NM 87531-0037
(505) 579-4680
(505) 579-4074
Mailing address
PO BOX 37, 1102 STATE HIGHWAY 68, EMBUDO, NM 87531-0037
(505) 579-4680
(505) 579-4074
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
DD1074
NM
261QD0000X
Dental Clinic/Center
Primary
DD1953
NM
Other
Enumeration date
12/13/2016
Last updated
12/13/2016
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