Individual
DR. NICHOLAS RICHARD WITHEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
6588 E MAIN ST, FARMINGTON, NM 87402-5122
(505) 326-6800
Mailing address
6588 E MAIN ST, FARMINGTON, NM 87402-5122
(805) 729-3413
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D009005
AZ
Other
Enumeration date
07/11/2014
Last updated
12/18/2017
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