Organization
KENNETH W CHILDRESS DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH CHILDRESS DDS (PRESIDENT)
(719) 671-7369
Entity
Organization
Contact information
Practice address
721 MECHEM DR, SIERRA MALL #5, RUIDOSO, NM 88345-6911
(575) 257-0246
Mailing address
721 MECHEM DR, SIERRA MALL #5, RUIDOSO, NM 88345-6911
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2704
NM
Other
Enumeration date
09/24/2010
Last updated
03/14/2012
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