MEDICARE: TOURO UNIVERSITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	122300000X	Dentist
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
3	1223P0300X	Periodontics
4	1223X0008X	Oral and Maxillofacial Radiology Dentistry
5	124Q00000X	Dental Hygienist
6	1223P0700X	Prosthodontics
7	1223P0106X	Oral and Maxillofacial Pathology Dentistry
8	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
9	1223D0004X	Dental Anesthesiology
10	1223P0221X	Pediatric Dentistry
11	1223E0200X	Endodontics
12	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1083411433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOURO UNIVERSITY

Provider Business Mailing Address
First Line	:	2425 RIDGECREST DR SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-5129
Country	:	US
Telephone Number	:	505-658-8236
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 RIDGECREST DR SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-5129
Country	:	US
Telephone Number	:	505-658-8236
Fax Number	:

Authorized Official
Title or Position	:	BILLING LEAD
Name	:	ANASTASIA LYNN NOVOTNY
Credential	:
Telephone Number	:	914-374-5611

Provider Enumeration Date	:	02/25/2025
Last Update Date	:	12/17/2025

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Directions to “TOURO UNIVERSITY ” Practice Location

Language	Start Address	Practice Location

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