Healthcare Provider Details

I. General information

NPI: 1750835583
Provider Name (Legal Business Name): AFFORDABLE DENTURES - ALBUQUERQUE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4821 ALEXANDER BLVD NE
ALBUQUERQUE NM
87107-6820
US

IV. Provider business mailing address

4821 ALEXANDER BLVD NE
ALBUQUERQUE NM
87107-6820
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-2100
  • Fax:
Mailing address:
  • Phone: 505-345-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD2568
License Number StateNM

VIII. Authorized Official

Name: GARY R HERRON II
Title or Position: PRACTICE OWNER
Credential:
Phone: 505-345-2100