Healthcare Provider Details

I. General information

NPI: 1184853079
Provider Name (Legal Business Name): ALL 4 8'S PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 MONTGOMERY BLVD NE SUITE O
ALBUQUERQUE NM
87109-1405
US

IV. Provider business mailing address

6800 MONTGOMERY BLVD NE SUITE O
ALBUQUERQUE NM
87109-1405
US

V. Phone/Fax

Practice location:
  • Phone: 505-338-9833
  • Fax: 505-338-9834
Mailing address:
  • Phone: 505-338-9833
  • Fax: 505-338-9834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License NumberD1722
License Number StateNM

VIII. Authorized Official

Name: DR. CHRISTOPHER A. BUTTNER
Title or Position: OWNER
Credential: DDS
Phone: 505-338-9833