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NPI Code Detail

MEDICARE: APEX DENTAL

MEDICARE: APEX DENTAL
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDD4343NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2DD4343OTHERNMDENTIST LICENCE

General Provider Information

NPI Number : 1396250403
Entity Type Code : Organization
Provider Name (Legal Business Name) : APEX DENTAL
Provider Business Mailing Address
First Line : 6330 RIVERSIDE PLAZA LN NW STE 165
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87120-2160
Country : US
Telephone Number : 630-730-9676
Fax Number :
Provider Business Practice Location Address
First Line : 6330 RIVERSIDE PLAZA LN NW STE 165
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87120-2160
Country : US
Telephone Number : 630-730-9676
Fax Number :
Authorized Official
Title or Position : DENTIST
Name : SUNEEL KUMAR NAMBURI
Credential : DMD
Telephone Number : 630-730-9676
Provider Enumeration Date : 12/12/2017
Last Update Date : 09/19/2022

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Directions to “APEX DENTAL ” Practice Location

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