Provider Demographics
NPI:1972118685
Name:SOUTHWEST PERIODONTAL AND IMPLANTS
Entity Type:Organization
Organization Name:SOUTHWEST PERIODONTAL AND IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-522-2477
Mailing Address - Street 1:3045 E UNIVERSITY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-9147
Mailing Address - Country:US
Mailing Address - Phone:575-522-2477
Mailing Address - Fax:575-521-3556
Practice Address - Street 1:3045 E UNIVERSITY AVE STE A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-9147
Practice Address - Country:US
Practice Address - Phone:575-522-2477
Practice Address - Fax:575-521-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty