Provider Demographics
NPI:1386987253
Name:CHINEA DENTAL LLC
Entity type:Organization
Organization Name:CHINEA DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-268-1679
Mailing Address - Street 1:2101 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-3807
Mailing Address - Country:US
Mailing Address - Phone:575-268-1679
Mailing Address - Fax:505-990-7514
Practice Address - Street 1:2101 S 1ST ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-3807
Practice Address - Country:US
Practice Address - Phone:575-268-1679
Practice Address - Fax:505-990-7514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD32491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty