Healthcare Provider Details

I. General information

NPI: 1992226401
Provider Name (Legal Business Name): SUNSET DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 4TH ST NW STE 13
ALBUQUERQUE NM
87107-5762
US

IV. Provider business mailing address

6211 4TH ST NW STE 13
ALBUQUERQUE NM
87107-5762
US

V. Phone/Fax

Practice location:
  • Phone: 505-821-5437
  • Fax:
Mailing address:
  • Phone: 505-634-5541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDD4560
License Number StateNM

VIII. Authorized Official

Name: DR. TIMOTHY TANG NGO
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 505-821-5437