Provider Demographics
NPI:1043233430
Name:LAS CRUCES DENTAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:LAS CRUCES DENTAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAMANIEGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:575-523-1479
Mailing Address - Street 1:2569 E IDAHO AVE # A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4578
Mailing Address - Country:US
Mailing Address - Phone:575-523-1479
Mailing Address - Fax:575-523-2974
Practice Address - Street 1:2569 E IDAHO AVE # A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4578
Practice Address - Country:US
Practice Address - Phone:575-523-1479
Practice Address - Fax:575-523-2974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty