Healthcare Provider Details

I. General information

NPI: 1962896332
Provider Name (Legal Business Name): DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6747 ACADEMY RD NE SUITE A
ALBUQUERQUE NM
87109-3384
US

IV. Provider business mailing address

6747 ACADEMY RD NE SUITE A
ALBUQUERQUE NM
87109-3384
US

V. Phone/Fax

Practice location:
  • Phone: 505-822-5100
  • Fax: 505-822-5106
Mailing address:
  • Phone: 505-822-5100
  • Fax: 505-822-5106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: BELINDA C MELTON
Title or Position: MEMBER
Credential:
Phone: 505-822-5100