Provider Demographics
NPI:1184968992
Name:THIRTY-TWO PEARLS SMILE SPA
Entity type:Organization
Organization Name:THIRTY-TWO PEARLS SMILE SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:JODY
Authorized Official - Last Name:MCCAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN RDH
Authorized Official - Phone:575-236-1001
Mailing Address - Street 1:PO BOX 3087
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88221-3087
Mailing Address - Country:US
Mailing Address - Phone:575-236-1001
Mailing Address - Fax:
Practice Address - Street 1:114 W FOX ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-6212
Practice Address - Country:US
Practice Address - Phone:575-236-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH1521261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental