Healthcare Provider Details

I. General information

NPI: 1265529655
Provider Name (Legal Business Name): JUST FOR KIDS DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 COORS RD NW SUITE 1
ALBUQUERQUE NM
87120
US

IV. Provider business mailing address

3301 COORS RD NW SUITE 1
ALBUQUERQUE NM
87120
US

V. Phone/Fax

Practice location:
  • Phone: 505-839-3703
  • Fax: 505-839-3704
Mailing address:
  • Phone: 505-839-3703
  • Fax: 505-839-3704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL H MORTAJI
Title or Position: DENTIST
Credential: DDS
Phone: 505-839-3703