Healthcare Provider Details

I. General information

NPI: 1164650388
Provider Name (Legal Business Name): FELIX C. MADRID, D.D.S.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 SOUTHERN BLVD SE SUITE B-1
RIO RANCHO NM
87124-3760
US

IV. Provider business mailing address

2345 SOUTHERN BLVD SE SUITE B-1
RIO RANCHO NM
87124-3760
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-0111
  • Fax: 505-994-1004
Mailing address:
  • Phone: 505-892-0111
  • Fax: 505-994-1004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD1864
License Number StateNM

VIII. Authorized Official

Name: DR. FELIX C. MADRID
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 505-892-0111