Provider Demographics
NPI:1679311666
Name:RIO RANCHO SMILES
Entity type:Organization
Organization Name:RIO RANCHO SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARAREH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOKOOHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-977-3299
Mailing Address - Street 1:1316 JACKIE RD SE STE 200
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1045
Mailing Address - Country:US
Mailing Address - Phone:505-994-9693
Mailing Address - Fax:
Practice Address - Street 1:1316 JACKIE RD SE STE 200
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1045
Practice Address - Country:US
Practice Address - Phone:505-994-9693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental