Healthcare Provider Details

I. General information

NPI: 1467534289
Provider Name (Legal Business Name): CATHERINE MARY ELLIOTT RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE MARY WOLFINGTON RDH

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8104 CEDAR CREEK DR NW
ALBUQUERQUE NM
87120-3844
US

IV. Provider business mailing address

8104 CEDAR CREEK DR NW
ALBUQUERQUE NM
87120-3844
US

V. Phone/Fax

Practice location:
  • Phone: 505-615-0951
  • Fax: 505-792-6737
Mailing address:
  • Phone: 505-615-0951
  • Fax: 505-792-6737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH228
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: