Healthcare Provider Details

I. General information

NPI: 1649656877
Provider Name (Legal Business Name): ROBERT C. URQUHART DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 OSUNA RD NE SUITE 4-B
ALBUQUERQUE NM
87111-2087
US

IV. Provider business mailing address

8400 OSUNA RD NE SUITE 4-B
ALBUQUERQUE NM
87111-2087
US

V. Phone/Fax

Practice location:
  • Phone: 505-554-2575
  • Fax: 505-835-5136
Mailing address:
  • Phone: 505-554-2575
  • Fax: 505-835-5136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDD2593
License Number StateNM

VIII. Authorized Official

Name: DR. ROBERT C URQUHART
Title or Position: OWNER/DR
Credential: DDS
Phone: 505-554-2575