Healthcare Provider Details

I. General information

NPI: 1942298047
Provider Name (Legal Business Name): ALICIA ANN ABEYTA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 WYOMING BLVD NE STE Q
ALBUQUERQUE NM
87109-3859
US

IV. Provider business mailing address

8020 BEVERLY HILLS AVE NE
ALBUQUERQUE NM
87122-3606
US

V. Phone/Fax

Practice location:
  • Phone: 505-585-1342
  • Fax:
Mailing address:
  • Phone: 505-353-1184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD2626
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: