Provider Demographics
NPI:1457711434
Name:SETRA, KERIMA B (RDH)
Entity Type:Individual
Prefix:
First Name:KERIMA
Middle Name:B
Last Name:SETRA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:KERIMA
Other - Middle Name:B
Other - Last Name:SETRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:2625 MCNUTT RD
Mailing Address - Street 2:
Mailing Address - City:SUNLAND PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88063-9019
Mailing Address - Country:US
Mailing Address - Phone:575-589-1500
Mailing Address - Fax:575-589-1519
Practice Address - Street 1:2625 MCNUTT RD
Practice Address - Street 2:
Practice Address - City:SUNLAND PARK
Practice Address - State:NM
Practice Address - Zip Code:88063-0940
Practice Address - Country:US
Practice Address - Phone:575-589-1500
Practice Address - Fax:575-589-1519
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH2231124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist