Healthcare Provider Details

I. General information

NPI: 1528295888
Provider Name (Legal Business Name): UTOPIA DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2009
Last Update Date: 06/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 KATHRYN AVE SE
ALBUQUERQUE NM
87108-4709
US

IV. Provider business mailing address

5800 KATHRYN AVE SE
ALBUQUERQUE NM
87108-4709
US

V. Phone/Fax

Practice location:
  • Phone: 505-363-3435
  • Fax:
Mailing address:
  • Phone: 505-363-3435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDH-1351
License Number StateNM

VIII. Authorized Official

Name: MRS. DARLY BARKLEY
Title or Position: PRESIDENT/CEO
Credential: DENTAL HYGIENIST
Phone: 505-363-3435