Individual
KATHY LESLIE BACA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
201 K 2 BUFFALO TRAIL, PENASCO, NM 87553
(575) 251-8010
(575) 242-6214
Mailing address
99B STATE ROAD 73, VADITO, NM 87579-9000
(575) 251-8010
(505) 575-2426
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH4492
NM
Other
Enumeration date
10/21/2025
Last updated
10/21/2025
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