Provider Demographics
NPI:1225427396
Name:SANTA FE FAMILY DENTISTRY LTD
Entity Type:Organization
Organization Name:SANTA FE FAMILY DENTISTRY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-988-5850
Mailing Address - Street 1:1406 LUISA ST
Mailing Address - Street 2:STE 1
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4347
Mailing Address - Country:US
Mailing Address - Phone:505-988-5850
Mailing Address - Fax:
Practice Address - Street 1:4146 NEUMAN RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-3234
Practice Address - Country:US
Practice Address - Phone:810-941-8983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty