LEROY BACA (NPI# 1154314177) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154314177 |
| Entity Type | Individual |
| Full Name | LEROY BACA |
| Credential | DDS |
| Practice Address |
1960 N Date St T Or C NM 87901-3701 |
| Mailing Address |
255 Hwy 187 P.o Box 370 Hatch NM 87937-0370 |
| Practice Telephone | 5052673088 |
| Practice Fax Number | 5052671747 |
| Mailing Telephone | 5052673088 |
| Mailing Fax Number | 5052671747 |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | DD1705 | NM | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | 88079 | 05 |
| Street Address |
1960 N DATE ST |
| City | T OR C |
| State | NM |
| Zip Code | 87901-3701 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861027179 | Rebecca Joy Hobbs | Nurse Practitioner | 1960 N Date St, T Or C, NM 87901-3701 | 2020-03-06 |
| 1760038368 | Brenda F Bongetta | Physician Assistant | 1960 N Date St, T Or C, NM 87901 | 2019-08-11 |
| 1285295667 | Mary Ellen Hatcher | Nurse Practitioner | 1960 N Date St, T Or C, NM 87901-3701 | 2019-06-26 |
| 1861961930 | Kimberly A Hill | Nurse Practitioner | 1960 N Date St, T Or C, NM 87901-3701 | 2018-11-19 |
| 1801203906 | Jenna Lotz | Dentist | 1960 N Date St, T Or C, NM 87901-3701 | 2014-07-21 |
| 1386810331 | Myrna L Policarpio | Dentist | 1960 N Date St, T Or C, NM 87901-3701 | 2008-04-30 |
| 1306037635 | Verna Deal | Dental Hygienist | 1960 N Date St, T Or C, NM 87901-3701 | 2007-08-01 |
| 1801889209 | Mark Wiatt | Dentist | 1960 N Date St, T Or C, NM 87901-3701 | 2005-08-31 |
| 1023001013 | Carol Renninger | Counselor | 1960 N Date St, T Or C, NM 87901-3701 | 2005-08-25 |
| 1437142429 | Carol Morrell | Physician Assistant | 1960 N Date St, T Or C, NM 87901-3701 | 2005-08-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548769011 | Michele Foss | Social Worker | 801 Smith Ave, T Or C, NM 87901 | 2018-02-09 |
| 1487195368 | Steve Stewart | Hospitalist | 800 E. 9th Avenue, Truth Or Consequences, NM 87901 | 2017-03-13 |
| 1750837316 | Klanese Krystal Hatley | Occupational Therapy Assistant | 180 N. Date Street, T Or C, NM 87901 | 2016-09-01 |
| 1932513025 | Karen Grace Gullett | Registered Nurse | 800 East Ninth Ave, Sierra Vista Hospital, Truth Or Consequences, NM 87901 | 2014-06-17 |
| 1306269824 | Mary Louise Masingale | Case Manager/Care Coordinator | 1714 Carrie St., Truth Or Consequences (t. Or C), NM 87901 | 2014-02-04 |
| 1548402555 | Faustino C. Froilan | Internal Medicine | 800 East Ninth Avenue, Sierra Vista Hospital, Truth Or Consequences, NM 87901 | 2009-04-06 |
| 1285874735 | Lesley Jo Ping | Occupational Therapy Assistant | 1400 Silver St., Torc, NM 87901 | 2009-02-24 |
| 1437205978 | Bernie Hewett | Ophthalmology | 518 Date, Truth Or Consequences, NM 87901 | 2007-01-26 |
| 1497806764 | Ambercare Medical Supply Company. | Durable Medical Equipment & Medical Supplies | 908 N Date St, T Or C, NM 87901 | 2007-01-15 |
| 1831285568 | Constance Mae Moore | Chiropractor | 310 N. Broadway, Truth Or Consequences, NM 87901 | 2006-10-04 |
| Find all providers in zip 87901 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801203906 | Jenna Lotz | Dentist | 1960 N Date St, T Or C, NM 87901-3701 | 2014-07-21 |
| 1801889209 | Mark Wiatt | Dentist | 1960 N Date St, T Or C, NM 87901-3701 | 2005-08-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457959934 | Comfortable Dentistry 4u - Cottonwood, LLC | Dentist | 3613 Nm 528 Nw Ste D, Albuquerque, NM 87114-8918 | 2020-10-15 |
| 1295347326 | Sandya Vanathi Athigaman | Dentist | 612 N Canyon St, Carlsbad, NM 88220-5842 | 2020-08-19 |
| 1932729506 | Brenda Concepcion Acosta | Dentist | Aegd-1 University of New Mexico, Albuquerque, NM 87131-0001 | 2020-04-23 |
| 1730712357 | Dental Technology Trainers LLC | Dentist | 3 Calle Del Arroyo, Placitas, NM 87043-9407 | 2020-02-21 |
| 1942833199 | Salud Dental Group Albuquerque | Dentist | 3803 Atrisco Dr Nw Ste D, Albuquerque, NM 87120-4958 | 2020-02-17 |
| 1669012241 | Lc Sleep Solutions LLC | Dentist | 2001 E Lohman Ave Ste 122, Las Cruces, NM 88001-3195 | 2020-01-10 |
| 1255987616 | Katelyn Noelle Bobbitt | Dentist | 950 Unser Blvd Se Ste 100, Rio Rancho, NM 87124-6376 | 2019-08-12 |
| 1336793892 | Lee Paige Affholter | Dentist | 6349 Us 550, Cuba, NM 87013 | 2019-08-01 |
| 1073167789 | Kathryn Susanne Wynne | Dentist | 5131 Main St Ste 101, Santa Fe, NM 87507-2682 | 2019-07-31 |
| 1033770953 | Chad Joseph Davis | Dentist | 3811 Cerrillos Rd Ste 104, Santa Fe, NM 87507-4149 | 2019-06-21 |
| Find all providers with the same taxonomy | ||||
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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.