Healthcare Provider Details

I. General information

NPI: 1568854339
Provider Name (Legal Business Name): PAPWORTH ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10151 MONTGOMERY BLVD NE SUITE 1-C
ALBUQUERQUE NM
87111-3670
US

IV. Provider business mailing address

10151 MONTGOMERY BLVD NE SUITE 1-C
ALBUQUERQUE NM
87111-3670
US

V. Phone/Fax

Practice location:
  • Phone: 505-294-3636
  • Fax:
Mailing address:
  • Phone: 505-294-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: BRIAN R PAPWORTH
Title or Position: OWNER
Credential:
Phone: 505-294-3636