TAOS COUNTY DENTAL LLC NPI 1881103026

NPI Information

NPI: 1881103026
Provider Name: TAOS COUNTY DENTAL LLC
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

CLIA Number: 32D2098740

Address:
105 PASEO DEL CANON W STE B
TAOS, NM
ZIP 87571
Phone: (575) 758-3205
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TAOS COUNTY DENTAL LLC is a dental clinic center in Taos, NM. TAOS COUNTY DENTAL LLC NPI is 1881103026. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

105 PASEO DEL CANON W STE B
TAOS, NM
ZIP 87571-943
Phone: (575) 758-3205
Fax: (575) 758-3756

The provider's authorized official is Michelle Olson .
The authorized official title is Regional Human Resource Director and has the following contact phone number (719) 344-5693.

The CLIA number assigned to this NPI record is 32D2098740 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/20/2017 and was last updated on 9/20/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223G0001X	Dentist	General Practice			No
2	261QD0000X	Clinic/Center	Dental	202298	COLORADO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	3889262	MEDICAID	COLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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