Healthcare Provider Details

I. General information

NPI: 1427861848
Provider Name (Legal Business Name): KHG ORTHO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10425 MONTGOMERY PKWY NE
ALBUQUERQUE NM
87111-3864
US

IV. Provider business mailing address

10425 MONTGOMERY PKWY NE
ALBUQUERQUE NM
87111-3864
US

V. Phone/Fax

Practice location:
  • Phone: 505-831-1600
  • Fax:
Mailing address:
  • Phone: 505-831-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KARI GRAEBER
Title or Position: OWNER
Credential: DDS, MS
Phone: 505-550-1778