Healthcare Provider Details

I. General information

NPI: 1740135169
Provider Name (Legal Business Name): UNCOMMON PC 1514 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 COORS BLVD NW STE A
ALBUQUERQUE NM
87121-1105
US

IV. Provider business mailing address

1514 COORS BLVD NW STE A
ALBUQUERQUE NM
87121-1105
US

V. Phone/Fax

Practice location:
  • Phone: 505-257-2000
  • Fax: 505-859-3950
Mailing address:
  • Phone: 505-257-2000
  • Fax: 505-859-3950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: AISHA WILLIAMS
Title or Position: COO
Credential:
Phone: 830-347-1844