Healthcare Provider Details

I. General information

NPI: 1770879694
Provider Name (Legal Business Name): UNM MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 CAMINO DE SALUD NE SUITE 1100
ALBUQUERQUE NM
87102-4516
US

IV. Provider business mailing address

933 BRADBURY DR SE SUITE 2222
ALBUQUERQUE NM
87106-4374
US

V. Phone/Fax

Practice location:
  • Phone: 505-925-4301
  • Fax:
Mailing address:
  • Phone: 505-272-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GARY CUTTRELL
Title or Position: CHIEF ASSISTANT PROFESSOR
Credential: D.D.S., J.D.
Phone: 505-272-1161