Organization
PROFESSIONAL DENTAL CARE OF NORTHERN NEW MEXICO II
Active
Parent organization
SSUN HEALTH, LLC
Other names
Northern New Mexico Center for Cosmetic Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
SSUN HEALTH, LLC
Authorized official
CARY LACOUTURE DDS (CLINICAL MANAGER)
(303) 521-5701
Entity
Organization
Contact information
Practice address
1337 GUSDORF RD STE A, TAOS, NM 87571-6296
(505) 751-9661
Mailing address
10233 S PARKER RD STE 107, PARKER, CO 80134-9314
(303) 521-5701
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/12/2021
Last updated
01/12/2021
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