MEDICARE: ALICIA A. ABEYTA DDS LLC

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
1	122300000X	Dentist	DD2626	NM

General Provider Information

NPI Number	:	1881825214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALICIA A. ABEYTA DDS LLC

Provider Business Mailing Address
First Line	:	4830 JUAN TABO BLVD NE STE K
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2682
Country	:	US
Telephone Number	:	505-293-7611
Fax Number	:

Provider Business Practice Location Address
First Line	:	4830 JUAN TABO BLVD NE STE K
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2682
Country	:	US
Telephone Number	:	505-293-7611
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ALICIA A ABEYTA
Credential	:	DDS
Telephone Number	:	505-293-7611

Provider Enumeration Date	:	08/03/2009
Last Update Date	:	08/03/2009

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