Healthcare Provider Details

I. General information

NPI: 1215313192
Provider Name (Legal Business Name): ABQ DENTAL HYGIENE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 SEATTLE SLEW AVE SE
ALBUQUERQUE NM
87123-2326
US

IV. Provider business mailing address

717 ENCINO PL NE SUITE 7
ALBUQUERQUE NM
87102-2611
US

V. Phone/Fax

Practice location:
  • Phone: 505-507-2227
  • Fax:
Mailing address:
  • Phone: 505-507-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH 1495
License Number StateNM

VIII. Authorized Official

Name: LYUDMILA SHAPIRO
Title or Position: REGISTERED DENTAL HYGIENIST
Credential: RDH
Phone: 505-507-2227