Healthcare Provider Details

I. General information

NPI: 1164853032
Provider Name (Legal Business Name): FAMILY DENTAL CENTERS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 MONTANO RD NW A3
ALBUQUERQUE NM
87120-2428
US

IV. Provider business mailing address

4801 MONTANO RD NW A3
ALBUQUERQUE NM
87120-2428
US

V. Phone/Fax

Practice location:
  • Phone: 505-898-4504
  • Fax: 505-899-0525
Mailing address:
  • Phone: 505-898-4504
  • Fax: 505-899-0525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1516
License Number StateNM

VIII. Authorized Official

Name: DR. STEVEN P ANDERSON
Title or Position: OWNER
Credential: DDS
Phone: 505-898-4504