Healthcare Provider Details

I. General information

NPI: 1508092750
Provider Name (Legal Business Name): BEST SMILES TWO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 MENAUL BLVD NE
ALBUQUERQUE NM
87110-3238
US

IV. Provider business mailing address

5820 MENAUL BLVD NE
ALBUQUERQUE NM
87110-3238
US

V. Phone/Fax

Practice location:
  • Phone: 505-872-2772
  • Fax:
Mailing address:
  • Phone: 505-872-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CRAIG BAHR
Title or Position: MEMBER
Credential: D.M.D.
Phone: 505-872-2772