EASTERN NEW MEXICO ENDODONTICS, PC (NPI# 1093261455) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093261455 |
| Entity Type | Organization |
| Organization Name | EASTERN NEW MEXICO ENDODONTICS, PC |
| Practice Address |
2000 W 21st St Suite L1 Clovis NM 88101-4087 |
| Practice Telephone | 5757628000 |
| Practice Fax Number | 5757630418 |
| Mailing Telephone | 5757628000 |
| Mailing Fax Number | 5757630418 |
| Enumeration Date | 2016-08-26 |
| Last Update Date | 2016-08-26 |
| Authorized Official Name | MR. CHAD RICKY SOUTHARD (ADMINISTRATOR) |
| Authorized Official Telephone | 8067974455 |
| Authorized Official Credential | FACHE, FHFMA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| Street Address |
2000 W 21ST ST SUITE L1 |
| City | CLOVIS |
| State | NM |
| Zip Code | 88101-4087 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982601498 | Debra L Cyphert | Nurse Practitioner | 2000 W 21st St, Suite E3, Clovis, NM 88101-4087 | 2005-06-30 |
| 1184011389 | A Romero Enterprises L.L.C. | Clinic/Center | 2000 W 21st St, Suite E3, Clovis, NM 88101-4087 | 2015-04-25 |
| 1396131611 | Annette Ternes | Registered Nurse | 2000 W 21st St, Suite E3, Clovis, NM 88101-4087 | 2015-04-14 |
| 1821492638 | Melissa Ashley Sprinkle | Nurse Practitioner | 2000 W 21st St, Suite A-1, Clovis, NM 88101-4087 | 2014-10-22 |
| 1952732125 | Nicole T. Musshorn | Advanced Practice Midwife | 2000 W 21st St, Ste A-1, Clovis, NM 88101-4087 | 2013-12-12 |
| 1316228265 | Larissa A Juberg | Advanced Practice Midwife | 2000 W 21st St, Ste A-1, Clovis, NM 88101-4087 | 2011-09-06 |
| 1821272394 | Sarah Jo Welch | Dentist | 2000 W 21st St, Suite L1, Clovis, NM 88101-4087 | 2007-12-20 |
| 1891825162 | Jacob Haskell Moberly | Dentist | 2000 W 21st St, Ste L1, Clovis, NM 88101-4087 | 2007-03-06 |
| 1538209994 | Mahamadu Fuseini | Internal Medicine | 2000 W 21st St, Clovis, NM 88101-4087 | 2007-02-07 |
| 1457498321 | Eye Associates of New Mexico, Ltd. | Optometrist | 2000 W 21st St, Suite R-1, Clovis, NM 88101-4087 | 2007-01-31 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134748692 | Patrick James Scollon | Military Health Care Provider | 104 W D. L. Ingram Ave, Cannon Afb, Nm 88101, Cannon Afb, NM 88101 | 2020-04-14 |
| 1285274878 | Keishla Cota | Physical Therapist | 100 East Manana Blvd, Unit 1, Clovis, NM 88101 | 2020-01-10 |
| 1659927283 | Ndeye Ndour | Nurse Anesthetist, Certified Registered | 2100 N M.l.k. Jr Blvd, Clovis, NM 88101 | 2019-08-09 |
| 1679132468 | Justine Nicole Nunez | Nurse Practitioner | 2301 North Doctor Martin Luther King Boulevard, Clovis, NM 88101 | 2019-06-06 |
| 1518453521 | Moore Psychological Services, Pllc | Social Worker | 1908 West 21st Street, Clovis, NM 88101 | 2018-07-03 |
| 1912494006 | Raesha Russell | Behavior Technician | 214 West 9th St, Clovis, NM 88101 | 2018-04-16 |
| 1013425800 | Vanessa Yardley | Registered Nurse | 2100 N. Martin Luther King Jr. Blvd., Clovis, NM 88101 | 2018-01-16 |
| 1699204230 | Olivia Garcia | Technician, Other | 1100 W 21st Street, Clovis, NM 88101 | 2017-06-07 |
| 1578006250 | Mary Ellen Gray | Technician, Other | 9408 B Vermont Court, Clovis, NM 88101 | 2016-11-29 |
| 1205296977 | Malaney Harmon | Behavioral Analyst | 2700 E 7th St., Clovis, NM 88101 | 2016-02-24 |
| Find all providers in zip 88101 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750804266 | Signature Smiles Practice of Owji | Clinic/Center | 255 W Bullard Ave Ste 106, Clovis, CA 93612-0861 | 2017-07-18 |
| 1336682459 | Sekhon and Cheema Dental Corporation | Clinic/Center | 1057 N Willow Ave Ste 117, Clovis, CA 93611-4414 | 2016-11-21 |
| 1336505916 | Clovis Family Dentistry, LLC | Clinic/Center | 2000 W 21st St Ste L1, Clovis, NM 88101-1400 | 2016-01-12 |
| 1720686892 | Bayrakdarian Clovis I, D.m.d., Inc., A Professional Dental Corporation | Clinic/Center | 451 Clovis Ave Ste 105, Clovis, CA 93612-1197 | 2020-10-12 |
| 1922583004 | Golden Valley Smiles | Clinic/Center | 1010 Shaw Ave, Clovis, CA 93612-3950 | 2018-09-25 |
| 1639443575 | Otto R. Alonzo, D.d.s., Inc. | Clinic/Center | 145 Shaw Ave, Suite B2, Clovis, CA 93612-3841 | 2012-02-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194358762 | Raton Family Dental LLC | Clinic/Center | 1100 S 2nd St Ste C, Raton, NM 87740-2326 | 2020-02-21 |
| 1700362589 | Morningstar Family Dental, LLC | Clinic/Center | 1005 Main St Sw, Los Lunas, NM 87031-8310 | 2018-07-16 |
| 1124512488 | Stacey Montano Dds LLC | Clinic/Center | 3901 Georgia St Ne Ste G1, Albuquerque, NM 87110-1388 | 2018-06-20 |
| 1003300393 | Napa Dental Management, LLC | Clinic/Center | 10820 Comanche Rd Ne Ste D, Albuquerque, NM 87111-3983 | 2018-06-19 |
| 1396243390 | Las Brisas Enterprises, LLC | Clinic/Center | 1209 Bonita Ave Suite A, Grants, NM 87020 | 2018-01-25 |
| 1780195024 | Devin Giron, Dds | Clinic/Center | 2 Calle Medico Ste 3, Santa Fe, NM 87505-4785 | 2017-10-13 |
| 1679017453 | Embudo Dental Center LLC | Clinic/Center | 1102 State Highway 68, Embudo, NM 87531-0037 | 2016-12-13 |
| 1871042457 | Dental House Trade Winds, LLC | Clinic/Center | 5400 Central Ave Se, Suite C-101, Albuquerque, NM 87108-1502 | 2016-09-24 |
| 1528437258 | Anywhere Dental Care | Clinic/Center | 28 Canada De Los Alamos Trl Se, Albuquerque, NM 87123-9504 | 2015-09-23 |
| 1871961045 | Gregory R Mcallister, Dds, LLC | Clinic/Center | 5910 Cubero Dr Ne Ste B, Albuquerque, NM 87109-3868 | 2015-09-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.