Provider Demographics
NPI:1629596705
Name:DDS CATALYST FARMINGTON, LLC
Entity Type:Organization
Organization Name:DDS CATALYST FARMINGTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHBY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-810-2890
Mailing Address - Street 1:3501 N BUTLER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6430
Mailing Address - Country:US
Mailing Address - Phone:505-564-4470
Mailing Address - Fax:505-325-9707
Practice Address - Street 1:3501 N BUTLER AVE STE 104
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6430
Practice Address - Country:US
Practice Address - Phone:505-564-4470
Practice Address - Fax:505-325-9707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty