Provider Demographics
NPI:1497254825
Name:MOUNTAIN VIEW DENTAL RUIDOSO
Entity Type:Organization
Organization Name:MOUNTAIN VIEW DENTAL RUIDOSO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-257-9053
Mailing Address - Street 1:127 EL PASO RD
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-6942
Mailing Address - Country:US
Mailing Address - Phone:575-257-9053
Mailing Address - Fax:575-258-1194
Practice Address - Street 1:127 EL PASO RD
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6942
Practice Address - Country:US
Practice Address - Phone:575-257-9053
Practice Address - Fax:575-258-1194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD36941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty