Provider Demographics
NPI:1891763074
Name:CLAIRE, MARIE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:E
Last Name:CLAIRE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 W SCHARBAUER ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-5132
Mailing Address - Country:US
Mailing Address - Phone:505-393-4481
Mailing Address - Fax:505-393-4551
Practice Address - Street 1:316 W SCHARBAUER ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-5132
Practice Address - Country:US
Practice Address - Phone:505-393-4481
Practice Address - Fax:505-393-4551
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD23361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM97120502Medicaid