Healthcare Provider Details

I. General information

NPI: 1851450175
Provider Name (Legal Business Name): BRIAN R PAPWORTH DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 09/24/2009
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: 505-294-4245
Mailing address:
  • Phone: 505-294-3636
  • Fax: 505-294-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDD1759
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: