NPI 1912923475

Kenneth Childress, DDS

Practitioner General Practice Dentistry Ruidoso, NM

Practice location

Address: 721 Mechem Dr Sierra Mall #5, Ruidoso, NM 88345-6911
Phone: (575) 257-0246
Fax: (575) 257-0249

Registered specialties (2)

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X Licence 2704 (NM)

Other Dentist providers in New Mexico →

General Practice Dentistry

Dental Providers Taxonomy 1223G0001X Licence 8164 (CO)

Registry record

NPI: 1912923475
Entity type: Individual
Sex (as registered): Male
NPI issued: 15 Jul 2006
Record last updated: 24 Apr 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.