Healthcare Provider Details

I. General information

NPI: 1003527458
Provider Name (Legal Business Name): NM DENTAL IMPLANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 MONTGOMERY BLVD NE STE B
ALBUQUERQUE NM
87107-4846
US

IV. Provider business mailing address

3520 MONTGOMERY BLVD NE STE B
ALBUQUERQUE NM
87107-4846
US

V. Phone/Fax

Practice location:
  • Phone: 505-705-8808
  • Fax: 505-705-8905
Mailing address:
  • Phone: 505-705-8808
  • Fax: 505-705-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. JACOB ROGERS
Title or Position: MANAGING MEMBER
Credential: DDS
Phone: 505-350-3786