Provider Demographics
NPI:1598755076
Name:LOPEZ-HINDS, SAMANTHA (RDH)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:LOPEZ-HINDS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 824
Mailing Address - Street 2:#15 CNTHY RD 329
Mailing Address - City:TIERRA AMARILLA
Mailing Address - State:NM
Mailing Address - Zip Code:87575-0824
Mailing Address - Country:US
Mailing Address - Phone:505-588-7968
Mailing Address - Fax:505-756-2821
Practice Address - Street 1:211 NORTH PINE
Practice Address - Street 2:
Practice Address - City:CHAMA
Practice Address - State:NM
Practice Address - Zip Code:87520
Practice Address - Country:US
Practice Address - Phone:505-756-2901
Practice Address - Fax:505-756-2821
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH1220124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist