Healthcare Provider Details

I. General information

NPI: 1942833199
Provider Name (Legal Business Name): SALUD DENTAL GROUP ALBUQUERQUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3803 ATRISCO DR NW STE D
ALBUQUERQUE NM
87120-4958
US

IV. Provider business mailing address

3803 ATRISCO DR NW STE D
ALBUQUERQUE NM
87120-4958
US

V. Phone/Fax

Practice location:
  • Phone: 505-833-1550
  • Fax: 505-831-8726
Mailing address:
  • Phone: 505-833-1550
  • Fax: 505-831-8726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MARCIA I CHAVEZ
Title or Position: FRONT ADMIN
Credential:
Phone: 505-833-1550