Provider Demographics
NPI:1629305743
Name:M. THOMAS ASHBROOK, DDS, PC
Entity Type:Organization
Organization Name:M. THOMAS ASHBROOK, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ASHBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:505-982-9816
Mailing Address - Street 1:2019 GALISTEO ST STE N7
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2111
Mailing Address - Country:US
Mailing Address - Phone:505-982-9816
Mailing Address - Fax:505-982-3707
Practice Address - Street 1:2019 GALISTEO ST STE N7
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2111
Practice Address - Country:US
Practice Address - Phone:505-982-9816
Practice Address - Fax:505-982-3707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1634122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty