Provider Demographics
NPI:1700907995
Name:FARMINGTON ENDODONTICS, PC
Entity Type:Organization
Organization Name:FARMINGTON ENDODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:RISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-793-4976
Mailing Address - Street 1:PO BOX 2932
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-2932
Mailing Address - Country:US
Mailing Address - Phone:505-793-4976
Mailing Address - Fax:505-327-6156
Practice Address - Street 1:708 E 20TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4205
Practice Address - Country:US
Practice Address - Phone:505-793-4976
Practice Address - Fax:505-327-6156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD25511223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty