Healthcare Provider Details

I. General information

NPI: 1508840554
Provider Name (Legal Business Name): LORRAINE F ZIEGLER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COORS BLVD NW SUITE E1
ALBUQUERQUE NM
87121-2006
US

IV. Provider business mailing address

2001 N CENTROL FAMILIAR SW
ALBUQUERQUE NM
87105
US

V. Phone/Fax

Practice location:
  • Phone: 505-833-0024
  • Fax: 505-873-7473
Mailing address:
  • Phone: 508-833-0024
  • Fax: 505-873-7473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH457
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: