Provider Demographics
NPI:1184608374
Name:ERNEST L. STROMEYER DDS MS PC
Entity type:Organization
Organization Name:ERNEST L. STROMEYER DDS MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STROMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:505-327-4872
Mailing Address - Street 1:2200 EAST 20TH STREET
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401
Mailing Address - Country:US
Mailing Address - Phone:505-327-4872
Mailing Address - Fax:505-327-4915
Practice Address - Street 1:2200 EAST 20TH STREET
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:505-327-4872
Practice Address - Fax:505-327-4915
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERNEST L. STROMEYER DDS MS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-01
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM10821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM6486Medicaid