Healthcare Provider Details

I. General information

NPI: 1134036999
Provider Name (Legal Business Name): ALISSA ARCIAGA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 JUAN TABO BLVD NE STE D
ALBUQUERQUE NM
87111-2627
US

IV. Provider business mailing address

11000 SNOWBIRD DR NW
ALBUQUERQUE NM
87114-5613
US

V. Phone/Fax

Practice location:
  • Phone: 505-850-4902
  • Fax:
Mailing address:
  • Phone: 505-240-0547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH3713
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: