Provider Demographics
NPI:1720160609
Name:TAFOYA, PETER J (DDS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:TAFOYA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 KIVA CT STE D
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5994
Mailing Address - Country:US
Mailing Address - Phone:505-988-3804
Mailing Address - Fax:505-988-5809
Practice Address - Street 1:404 KIVA CT STE D
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5994
Practice Address - Country:US
Practice Address - Phone:505-988-3804
Practice Address - Fax:505-988-5809
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1051122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist