Provider Demographics
NPI:1720678410
Name:WHITE SANDS FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:WHITE SANDS FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:575-434-1186
Mailing Address - Street 1:516 1ST ST STE J
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6511
Mailing Address - Country:US
Mailing Address - Phone:575-434-1186
Mailing Address - Fax:575-522-0454
Practice Address - Street 1:516 1ST ST STE J
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6511
Practice Address - Country:US
Practice Address - Phone:575-434-1186
Practice Address - Fax:575-522-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental