Provider Demographics
NPI:1831506831
Name:DARREN HALTOM SPECIALTY PARTNERS OF NM II, LLC
Entity type:Organization
Organization Name:DARREN HALTOM SPECIALTY PARTNERS OF NM II, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HALTOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:505-331-7473
Mailing Address - Street 1:10433 LAGRIMA DE ORO RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3727
Mailing Address - Country:US
Mailing Address - Phone:505-299-4458
Mailing Address - Fax:505-299-4450
Practice Address - Street 1:10433 LAGRIMA DE ORO
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111
Practice Address - Country:US
Practice Address - Phone:505-299-4458
Practice Address - Fax:505-299-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD20901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1336138684OtherENVOLVE BENEFIT OPTIONS
NM31672752Medicaid