Healthcare Provider Details

I. General information

NPI: 1467787747
Provider Name (Legal Business Name): RANDY G. ALKIRE,DDS,MS,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 JACKIE RD SE SUITE #300
RIO RANCHO NM
87124-6618
US

IV. Provider business mailing address

1316 JACKIE RD SE SUITE #300
RIO RANCHO NM
87124-6618
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-5749
  • Fax: 505-212-0673
Mailing address:
  • Phone: 505-892-5749
  • Fax: 505-212-0673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDD1958
License Number StateNM

VIII. Authorized Official

Name: DR. RANDY GAIL ALKIRE
Title or Position: PRESIDENT
Credential: DDS, MS, PC
Phone: 505-892-5749