Healthcare Provider Details

I. General information

NPI: 1396930186
Provider Name (Legal Business Name): ASHLEE LAUREN BOWER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEE LAUREN BERGER DMD

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LAMBERTON PL NE STE W
ALBUQUERQUE NM
87107-1659
US

IV. Provider business mailing address

901 LAMBERTON SUITE W
ALBUQUERQUE NM
87107
US

V. Phone/Fax

Practice location:
  • Phone: 505-323-1300
  • Fax: 505-323-1400
Mailing address:
  • Phone: 505-323-1300
  • Fax: 505-323-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD2941
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7389
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: