Healthcare Provider Details

I. General information

NPI: 1104181049
Provider Name (Legal Business Name): SANDRA JOYCE BARTEE RDH,BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NOVITSKI HL 1 UNM
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

10412 MANZANILLO AVE NE
ALBUQUERQUE NM
87111-1725
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4106
  • Fax:
Mailing address:
  • Phone: 505-294-8178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number308
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: