Healthcare Provider Details

I. General information

NPI: 1720768658
Provider Name (Legal Business Name): COLAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 PAN AMERICAN FWY NE STE A
ALBUQUERQUE NM
87107-1650
US

IV. Provider business mailing address

2709 PAN AMERICAN FWY NE STE A
ALBUQUERQUE NM
87107-1650
US

V. Phone/Fax

Practice location:
  • Phone: 505-798-2532
  • Fax:
Mailing address:
  • Phone: 505-798-2532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code292200000X
TaxonomyDental Laboratory
License Number
License Number State

VIII. Authorized Official

Name: PHILIP FREISINGER
Title or Position: PRESIDENT
Credential:
Phone: 505-798-2532