Healthcare Provider Details

I. General information

NPI: 1164694287
Provider Name (Legal Business Name): COTTONWOOD ORTHODONTICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 ELLISON RD NW SUITE B
ALBUQUERQUE NM
87114-7009
US

IV. Provider business mailing address

3730 ELLISON RD NW SUITE B
ALBUQUERQUE NM
87114-7009
US

V. Phone/Fax

Practice location:
  • Phone: 505-766-4800
  • Fax: 505-898-5270
Mailing address:
  • Phone: 505-766-4800
  • Fax: 505-898-5270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDD1985
License Number StateNM

VIII. Authorized Official

Name: DR. CARLOS TORREBIARTE
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 505-766-4800