Provider Demographics
NPI:1033527155
Name:NIETO, EMILY H (DMD, MPH)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:H
Last Name:NIETO
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:HARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-0158
Mailing Address - Country:US
Mailing Address - Phone:505-753-7218
Mailing Address - Fax:505-747-7396
Practice Address - Street 1:007 CHOOSGAI DRIVE
Practice Address - Street 2:
Practice Address - City:TOHATCHI
Practice Address - State:NM
Practice Address - Zip Code:87325
Practice Address - Country:US
Practice Address - Phone:505-733-8400
Practice Address - Fax:575-763-9154
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2017-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD41221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice