Provider Demographics
NPI:1740775022
Name:ZACHCURRIEDDS LLC
Entity Type:Organization
Organization Name:ZACHCURRIEDDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZACH
Authorized Official - Middle Name:
Authorized Official - Last Name:CURRIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-281-0373
Mailing Address - Street 1:PO BOX 2560
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-2560
Mailing Address - Country:US
Mailing Address - Phone:505-281-0373
Mailing Address - Fax:
Practice Address - Street 1:1851 OLD US 66 STE C
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-6784
Practice Address - Country:US
Practice Address - Phone:505-281-0373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM33771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1710297486OtherDENTIST
1396870861OtherASSOCIATE