Provider Demographics
NPI:1376656637
Name:ADAY, B JOE (DDS)
Entity Type:Individual
Prefix:
First Name:B
Middle Name:JOE
Last Name:ADAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 MISSOURI AVE STE D
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5091
Mailing Address - Country:US
Mailing Address - Phone:505-522-1500
Mailing Address - Fax:505-521-1529
Practice Address - Street 1:2701 MISSOURI AVE STE D
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5091
Practice Address - Country:US
Practice Address - Phone:505-522-1500
Practice Address - Fax:505-521-1529
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM11861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics