Healthcare Provider Details

I. General information

NPI: 1104594878
Provider Name (Legal Business Name): MOUNTAIN VIEW FAMILY DENTISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 JAGER DR NE STE C1
RIO RANCHO NM
87144-5715
US

IV. Provider business mailing address

4405 JAGER DR NE STE C1
RIO RANCHO NM
87144-5715
US

V. Phone/Fax

Practice location:
  • Phone: 505-867-1442
  • Fax: 505-867-1438
Mailing address:
  • Phone: 505-867-1442
  • Fax: 505-867-1438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANACHELICA KEITH
Title or Position: MANAGER
Credential:
Phone: 505-867-1442