Provider Demographics
NPI:1831410745
Name:NEW MEXICO SMILES, INC.
Entity type:Organization
Organization Name:NEW MEXICO SMILES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:STRONG
Authorized Official - Last Name:BUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:575-218-3541
Mailing Address - Street 1:3812 BENJAMIN DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-2721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3812 BENJAMIN DAVIS DR
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-2721
Practice Address - Country:US
Practice Address - Phone:575-218-3541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD3014122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty