Healthcare Provider Details

I. General information

NPI: 1922799816
Provider Name (Legal Business Name): SUCCESS SMILES ORTHODONTICS SOUTH VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6660 CENTRAL AVE SW
ALBUQUERQUE NM
87121-2029
US

IV. Provider business mailing address

8216 LOUISIANA BLVD NE
ALBUQUERQUE NM
87113-2105
US

V. Phone/Fax

Practice location:
  • Phone: 505-569-6639
  • Fax:
Mailing address:
  • Phone: 505-569-6639
  • 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. LIGIA PADILLA
Title or Position: ORTHODONTIST/OWNER
Credential: DDS
Phone: 505-569-6639