Organization
DENTAL ASSOCIATES PA
Active
Other names
Dental Associates PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID A. SUDIMACK D.D.S. (PRESIDENT)
(575) 522-7320
Entity
Organization
Contact information
Practice address
2205 S SOLANO DR, LAS CRUCES, NM 88001
(505) 522-7320
(505) 522-6395
Mailing address
2205 S SOLANO DR, LAS CRUCES, NM 88001
(505) 522-7320
(505) 522-6395
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
NM1518
NM
1223G0001X
General Practice Dentistry
Primary
NM2258
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
806920
UNITED CONCORDIA INS
—
01
—
8403
BLUE CROSS BLUE SHIELD
NM
Enumeration date
09/06/2006
Last updated
11/08/2012
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