Individual
AMANDA JO BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
710 E SANTA FE, GRANTS, NM 87020-3926
(505) 350-6046
Mailing address
1611 TERRACE LOOP, GRANTS, NM 87020-3926
(505) 350-6046
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH2920
NM
Other
Enumeration date
10/30/2025
Last updated
10/30/2025
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