Provider Demographics
NPI:1558666883
Name:PLAINS DENTAL
Entity Type:Organization
Organization Name:PLAINS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:O'QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:575-742-3100
Mailing Address - Street 1:121 W LLANO ESTACADO BLVD
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101
Mailing Address - Country:US
Mailing Address - Phone:575-742-3100
Mailing Address - Fax:575-742-3400
Practice Address - Street 1:121 W LLANO ESTACADO BLVD
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101
Practice Address - Country:US
Practice Address - Phone:575-742-3100
Practice Address - Fax:575-742-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD1887122300000X
NMDD3395122300000X
NMDH1504124Q00000X
NMDH2245124Q00000X
NMDH2884124Q00000X
NMDA3975126800000X
NMDA2349126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No126800000XDental ProvidersDental AssistantGroup - Single Specialty