Individual
MARY ELIZABETH HETSKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
546 N 10TH STREET, FORT SUMNER, NM 88119
(505) 355-7779
(505) 355-7894
Mailing address
7806 ALASKA CT APT B, CLOVIS, NM 88101-8492
(505) 355-7779
(505) 355-7894
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD2745
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD2745
NM BOARD OF DENTAL HEALTH
NM
Enumeration date
01/24/2007
Last updated
07/08/2007
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