Provider Demographics
NPI:1326038563
Name:DEMING DENTAL SERVICES, P.A.
Entity type:Organization
Organization Name:DEMING DENTAL SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES. CORP.
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-546-2684
Mailing Address - Street 1:400 S GOLD AVE
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-4159
Mailing Address - Country:US
Mailing Address - Phone:505-546-2684
Mailing Address - Fax:505-546-1106
Practice Address - Street 1:400 S GOLD AVE
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-4159
Practice Address - Country:US
Practice Address - Phone:505-546-2684
Practice Address - Fax:505-546-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM10721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM4908OtherDORAL DENTAL
TN3145509OtherBLUE CROSS OF TENNESSEE
NM839147OtherUNITED CONCORDIA
NM008656OtherBLUE CROSS & BLUE SHIELD
NM86546Medicaid