Healthcare Provider Details

I. General information

NPI: 1003300393
Provider Name (Legal Business Name): NAPA DENTAL MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/18/2023
Certification Date: 06/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10820 COMANCHE RD NE STE D
ALBUQUERQUE NM
87111-3983
US

IV. Provider business mailing address

10820 COMANCHE RD NE STE D
ALBUQUERQUE NM
87111-3983
US

V. Phone/Fax

Practice location:
  • Phone: 505-323-7700
  • Fax:
Mailing address:
  • Phone: 505-323-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KARTIK ANTANI
Title or Position: CEO
Credential: DMD
Phone: 848-565-5070