Healthcare Provider Details

I. General information

NPI: 1063610228
Provider Name (Legal Business Name): RYAN PAUL SAVAGE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10151 MONTGOMERY BLVD NE SUITE 2B
ALBUQUERQUE NM
87111
US

IV. Provider business mailing address

10151 MONTGOMERY BLVD NE SUITE 2B
ALBUQUERQUE NM
87111
US

V. Phone/Fax

Practice location:
  • Phone: 505-830-3636
  • Fax: 505-830-2305
Mailing address:
  • Phone: 505-830-3636
  • Fax: 505-830-2305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD2649
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: