Healthcare Provider Details

I. General information

NPI: 1396250403
Provider Name (Legal Business Name): APEX DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 RIVERSIDE PLAZA LN NW STE 165
ALBUQUERQUE NM
87120-2160
US

IV. Provider business mailing address

6330 RIVERSIDE PLAZA LN NW STE 165
ALBUQUERQUE NM
87120-2160
US

V. Phone/Fax

Practice location:
  • Phone: 630-730-9676
  • Fax:
Mailing address:
  • Phone: 630-730-9676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD4343
License Number StateNM

VIII. Authorized Official

Name: SUNEEL KUMAR NAMBURI
Title or Position: DENTIST
Credential: DMD
Phone: 630-730-9676