Healthcare Provider Details

I. General information

NPI: 1740104074
Provider Name (Legal Business Name): MARIAH DURAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10409 MONTGOMERY PKWY NE STE 201
ALBUQUERQUE NM
87111-3862
US

IV. Provider business mailing address

5509 BICE RD NW
ALBUQUERQUE NM
87105-1022
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-7479
  • Fax:
Mailing address:
  • Phone: 505-697-2984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDB-2026-0272
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: