SUMMIT FAMILY DENTAL OF KIRTLAND, LLC (NPI# 1710215439) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710215439 |
| Entity Type | Organization |
| Organization Name | SUMMIT FAMILY DENTAL OF KIRTLAND, LLC |
| Practice Address |
#3 Cr 6523 Kirtland NM 87417 |
| Practice Telephone | 5055986800 |
| Practice Fax Number | 5055986830 |
| Mailing Telephone | 5055986800 |
| Mailing Fax Number | 5055986830 |
| Enumeration Date | 2009-11-19 |
| Last Update Date | 2020-09-30 |
| Authorized Official Name | DR. CODY B COLEMAN (OWNER) |
| Authorized Official Telephone | 5055986800 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
DD2872 | NM | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | 99183064 | 05 |
| Street Address |
#3 CR 6523 |
| City | KIRTLAND |
| State | NM |
| Zip Code | 87417 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871973693 | Chris John Giblette | Dentist | #3 Cr 6523, Kirtland, NM 87417 | 2015-06-06 |
| 1851686430 | Bruce Brondon Shaheen | Dentist | #3 Cr 6523, Sundance Dental Care of Kirtland, Kirtland, NM 87417 | 2011-06-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619598265 | Kaitlynn C Medley | Behavior Technician | 115 Road 6480, Kirtland, NM 87417 | 2020-05-05 |
| 1093334930 | Hattie Marie Davis | Behavior Technician | 506 Road 6100, Kirtland, NM 87417-9316 | 2020-04-10 |
| 1841763398 | Melissa Christianson | Registered Nurse | 550 Road 6100, Kirtland, NM 87417-9317 | 2019-01-08 |
| 1245602127 | Jessica Dalton | Registered Nurse | 538 County Road 6100, Kirtland, NM 87417-9317 | 2015-10-30 |
| 1609102227 | Jessica L Spinner | Social Worker | 550 County Road 6100, Kirtland, NM 87417-9317 | 2009-11-02 |
| 1801856448 | Erica R Freeman | Physical Therapist | 583 County Road 6100, Kirtland, NM 87417-9318 | 2006-03-27 |
| 1598131195 | Tara Hannah | Physical Therapy Assistant | 68 Road 6118, Kirtland, NM 87417-9319 | 2015-08-18 |
| 1164850285 | Maria Gonzales | Speech-Language Pathologist | 31 Road 6195, Kirtland, NM 87417-9332 | 2013-10-29 |
| 1215579156 | Stephanie Lee Crawford | Registered Nurse | 538 County Road 6100, Kirtland, NM 87417-9337 | 2019-10-11 |
| 1902230402 | Jeffrey D. Cooper | Audiologist-Hearing Aid Fitter | 76c County Road 6500, Kirtland, NM 87417-9402 | 2013-09-03 |
| Find all providers in zip 87417 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093721920 | Jeffrey Charles Bailey | Dentist | 9191 Chillicothe Rd, Kirtland, OH 44094-9263 | 2006-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841803830 | Tri Dental, LLC | Dentist | 3715 Las Estancias Ct Sw Ste 101, Albuquerque, NM 87121-5506 | 2020-08-28 |
| 1609485077 | Joseph Potter | Dentist | 3510 Coors Blvd Sw, Albuquerque, NM 87121-5328 | 2020-07-30 |
| 1760090880 | Elizabeth Hays | Dentist | 1405 S Valley Dr Ste 300, Las Cruces, NM 88005-3132 | 2020-07-15 |
| 1861024861 | Brian K Dennis Dds PC | Dentist | 8400 Osuna Rd Ne Ste 6a, Albuquerque, NM 87111-2073 | 2020-02-07 |
| 1285264242 | Professional Dental Care Pllc | Dentist | 550 Saint Michaels Dr Ste 2, Santa Fe, NM 87505-7604 | 2020-01-18 |
| 1134769235 | Abq Dentists PC | Dentist | 3900 Eubank Blvd Ne Ste 14, Albuquerque, NM 87111-3427 | 2020-01-07 |
| 1477197804 | Juan Tabo Dentistry LLC | Dentist | 1924 Juan Tabo Blvd Ne Ste C, Albuquerque, NM 87112-3358 | 2019-10-29 |
| 1013550094 | Bosque Smiles Dentistry, LLC | Dentist | 5600 Coors Blvd Nw Ste G4, Albuquerque, NM 87120-1877 | 2019-10-23 |
| 1336796473 | Salud Dental Group Chaparral | Dentist | 320 Mccombs Rd Ste E, Chaparral, NM 88081-7937 | 2019-08-22 |
| 1639725732 | John Jerome Fagel | Dentist | 07 Choos Gai Dr, Tohatchi, NM 87325 | 2019-08-14 |
| 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.