Healthcare Provider Details

I. General information

NPI: 1376926006
Provider Name (Legal Business Name): BECKY DINH CHIEM D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11130 LOMAS BLVD NE STE F2
ALBUQUERQUE NM
87112-5581
US

IV. Provider business mailing address

9912 LORELEI LN NE
ALBUQUERQUE NM
87111-1246
US

V. Phone/Fax

Practice location:
  • Phone: 505-369-6451
  • Fax:
Mailing address:
  • Phone: 626-551-1063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD4360
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: