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SUMMIT FAMILY DENTAL OF KIRTLAND, LLC
NPI 1710215439
Dentist - General Practice in Kirtland, NM

Active since November 19, 2009
#3 CR 6523, KIRTLAND, NM 87417(505) 598-6800(505) 598-6830 Get Directions Write a Review

NPPES record last updated: September 30, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Summit Family Dental Of Kirtland, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SUMMIT FAMILY DENTAL OF KIRTLAND, LLC (NPI 1710215439) is a healthcare organization registered as a general practice in Kirtland, New Mexico and active in the NPI registry since November 2009. The organization lists Cody B Coleman, Owner, as its authorized official.

NPPES Registry Identity

NPI1710215439
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameSUMMIT FAMILY DENTAL OF KIRTLAND, LLC
Location Address#3 CR 6523Kirtland, NM 87417
Mailing Address#3 Cr 6523Kirtland, NM 87417 · (505) 598-6800 · Fax (505) 598-6830
Phone(505) 598-6800
Fax(505) 598-6830
Organization SubpartNo
Authorized OfficialCody B ColemanOwner · (505) 598-6800
Enumeration DateNovember 19, 2009
Last NPPES UpdateSeptember 30, 2020
NPPES CertifiedSeptember 30, 2020
✔ NPI 1710215439 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in NM · DD2872
Definition
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.

Other Identifiers 1

Medicaid99183064NM

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BRUCE BRONDON SHAHEEN DDS
Dentist
#3 CR 6523, SUNDANCE DENTAL CARE OF KIRTLAND
KIRTLAND, NM 87417
San Juan County (505) 598-6800
DR. CHRIS JOHN GIBLETTE D.M.D
Dentist
#3 CR 6523
KIRTLAND, NM 87417
San Juan County (505) 598-6800

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Summit Family Dental Of Kirtland, LLC's NPI number?

The NPI number for Summit Family Dental Of Kirtland, LLC is 1710215439. It was assigned to this organization in the NPPES registry on November 19, 2009.

Where is Summit Family Dental Of Kirtland, LLC located?

Summit Family Dental Of Kirtland, LLC is located at #3 Cr 6523, Kirtland, NM 87417. The listed phone number is (505) 598-6800.

What is Summit Family Dental Of Kirtland, LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Summit Family Dental Of Kirtland, LLC was last updated on September 30, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.