Healthcare Provider Details

I. General information

NPI: 1225381007
Provider Name (Legal Business Name): ELIZA LINDQUIST D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 GOLF COURSE RD NW
ALBUQUERQUE NM
87120-5842
US

IV. Provider business mailing address

8201 GOLF COURSE RD NW
ALBUQUERQUE NM
87120-5842
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-9010
  • Fax: 505-899-4804
Mailing address:
  • Phone: 505-892-9010
  • Fax: 505-899-4804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number60895
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDD4056
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: