Healthcare Provider Details

I. General information

NPI: 1851899751
Provider Name (Legal Business Name): NEW MEXICO COMMUNITY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 HINKLE ST SE
ALBUQUERQUE NM
87102-4930
US

IV. Provider business mailing address

2116 HINKLE ST SE
ALBUQUERQUE NM
87102-4930
US

V. Phone/Fax

Practice location:
  • Phone: 505-843-7493
  • Fax:
Mailing address:
  • Phone: 505-843-7493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number StateNM

VIII. Authorized Official

Name: MR. KWEI TSCHEN
Title or Position: OWNER
Credential:
Phone: 216-904-2805