Healthcare Provider Details

I. General information

NPI: 1558792986
Provider Name (Legal Business Name): ACC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LAMBERTON PL NE STE W
ALBUQUERQUE NM
87107-1659
US

IV. Provider business mailing address

901 LAMBERTON PL NE STE W
ALBUQUERQUE NM
87107-1659
US

V. Phone/Fax

Practice location:
  • Phone: 505-323-1300
  • Fax: 505-323-1400
Mailing address:
  • Phone: 505-323-1300
  • Fax: 505-323-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDD2941
License Number StateNM

VIII. Authorized Official

Name: DR. ASHLEE BOWER
Title or Position: DENTAL DIRECTOR
Credential: DMD
Phone: 505-323-1300