Organization
LEA COUNTY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NISHANTH REDDY PUCHALAPALLI DDS (DENTIST)
(408) 306-8365
Entity
Organization
Contact information
Practice address
701 N MAIN AVE, LOVINGTON, NM 88260-3417
(408) 306-8365
Mailing address
701 N MAIN AVE, LOVINGTON, NM 88260-3417
(408) 306-8365
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
02/09/2016
Last updated
02/12/2016
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