Individual
MS. LYN M. ST. LOUIS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
DH
Contact information
Practice address
HOUSE#013405 STATE RD. 75 - HCNNM PENASCO DENTAL, PENASCO, NM 87553
(505) 587-2809
(505) 587-1944
Mailing address
111 N RAILROAD AVE, P.O. BOX 158, ESPANOLA, NM 87532-2627
(505) 753-7218
(505) 753-5815
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH2558
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81334397
—
NM
01
—
9177772
DORAL
NM
Enumeration date
08/31/2005
Last updated
07/09/2007
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