Provider Demographics
NPI:1659387090
Name:DESERT HILLS DENTAL GROUP
Entity Type:Organization
Organization Name:DESERT HILLS DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MELLEN
Authorized Official - Last Name:SCHUMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-327-4863
Mailing Address - Street 1:2525 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-4503
Mailing Address - Country:US
Mailing Address - Phone:505-327-4863
Mailing Address - Fax:505-327-5394
Practice Address - Street 1:2525 E 30TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4503
Practice Address - Country:US
Practice Address - Phone:505-327-4863
Practice Address - Fax:505-327-5394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM15861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty