Individual
MESHAN FOUTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1001 W BROADWAY, FARMINGTON, NM 87401-5638
(505) 327-4796
Mailing address
3120 RANCH CT, FARMINGTON, NM 87401-2577
(505) 309-8972
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107261061
DRIVERS LICENSE
—
Enumeration date
10/12/2022
Last updated
10/19/2022
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