Healthcare Provider Details

I. General information

NPI: 1780296137
Provider Name (Legal Business Name): SANDIA ORTHODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 OSUNA RD NE STE 2C
ALBUQUERQUE NM
87111-2069
US

IV. Provider business mailing address

8400 OSUNA RD NE STE 2C
ALBUQUERQUE NM
87111-2069
US

V. Phone/Fax

Practice location:
  • Phone: 505-293-2332
  • Fax:
Mailing address:
  • Phone:
  • 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: JEREMY KARRAS
Title or Position: OWNER
Credential: DDS
Phone: 515-240-5836