Professional Dental Care of Northern New Mexico I Professional
NPI #1457998106 in Santa Fe, New Mexico
Provider Information
- NPI Number
- 1457998106
- Entity Type
- Organization
- Organization Name
- Professional Dental Care of Northern New Mexico I Professional
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- PROFESSIONAL DENTAL CARE PLLC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Dec 2, 2019
- Last Updated
- Dec 2, 2019
Practice Location
- Address
- 550B SAINT MICHAELS DR STE 2
- City
- Santa Fe
- State
- New Mexico
- ZIP Code
- 87505-7716
- Phone
- (505) 471-7000
Authorized Official
- Name
- DR. FRED ANTHONY LACOURT, DDS
- Title
- CHIEF DENTAL OFFICER
- Phone
- (414) 303-7484
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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