Organization
SUMMIT FAMILY DENTAL OF KIRTLAND, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CODY B COLEMAN DDS (OWNER)
(505) 598-6800
Entity
Organization
Contact information
Practice address
#3 CR 6523, KIRTLAND, NM 87417
(505) 598-6800
(505) 598-6830
Mailing address
#3 CR 6523, KIRTLAND, NM 87417
(505) 598-6800
(505) 598-6830
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD2872
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
99183064
—
NM
Enumeration date
11/19/2009
Last updated
09/30/2020
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