Healthcare Provider Details

I. General information

NPI: 1326181587
Provider Name (Legal Business Name): PRECISION DENTAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7131 PROSPECT PL NE
ALBUQUERQUE NM
87110-4313
US

IV. Provider business mailing address

7131 PROSPECT PL NE
ALBUQUERQUE NM
87110-4313
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-6562
  • Fax: 505-883-8634
Mailing address:
  • Phone: 505-883-6562
  • Fax: 505-883-8634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDD1629
License Number StateNM

VIII. Authorized Official

Name: CRAIG THOMAS STEICHEN
Title or Position: OWNER OFFICER
Credential: DDS
Phone: 505-883-6562