Healthcare Provider Details

I. General information

NPI: 1942624655
Provider Name (Legal Business Name): NEW MEXICO ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2014
Last Update Date: 02/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 GOLF COURSE RD NW SUITE C-3
ALBUQUERQUE NM
87120-5842
US

IV. Provider business mailing address

8201 GOLF COURSE RD NW SUITE C-3
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 TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES TASKER
Title or Position: OWNER
Credential:
Phone: 505-892-9010