Healthcare Provider Details

I. General information

NPI: 1124287206
Provider Name (Legal Business Name): REDEMPTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 EUBANK N.E. SUITE 207
ALBUQUERQUE NM
87111-2565
US

IV. Provider business mailing address

4550 EUBANK N.E. SUITE 207
ALBUQUERQUE NM
87111-2565
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-9500
  • Fax:
Mailing address:
  • Phone: 505-291-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH HAMPTON BOWERS
Title or Position: MANAGER
Credential: DMD
Phone: 505-291-9500