Healthcare Provider Details

I. General information

NPI: 1376047795
Provider Name (Legal Business Name): ANNE K. HEMPSTEAD D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 HOLLY AVE NE STE M
ALBUQUERQUE NM
87113
US

IV. Provider business mailing address

4319 NAMBE CT
LAS CRUCES NM
88011-4290
US

V. Phone/Fax

Practice location:
  • Phone: 512-787-7174
  • Fax:
Mailing address:
  • Phone: 512-787-7174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SCOTT SIEGEL
Title or Position: OWNER
Credential: D.M.D.
Phone: 512-787-7174