Healthcare Provider Details

I. General information

NPI: 1417945429
Provider Name (Legal Business Name): SANDRA KAY ROE RDH, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 QUINCY ST NE
ALBUQUERQUE NM
87110-3054
US

IV. Provider business mailing address

2730 QUINCY ST NE
ALBUQUERQUE NM
87110-3054
US

V. Phone/Fax

Practice location:
  • Phone: 505-688-8058
  • Fax: 505-827-2557
Mailing address:
  • Phone: 505-688-8058
  • Fax: 505-827-2557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH 917
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: