Healthcare Provider Details

I. General information

NPI: 1720446164
Provider Name (Legal Business Name): MARA ESTHER SHINDELL D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4421 IRVING BLVD NW STE B
ALBUQUERQUE NM
87114-5919
US

IV. Provider business mailing address

4602 OVERLAND ST NE
ALBUQUERQUE NM
87109-2671
US

V. Phone/Fax

Practice location:
  • Phone: 505-821-6910
  • Fax: 505-792-5771
Mailing address:
  • Phone: 240-676-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number3594
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDD4594
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: