Healthcare Provider Details

I. General information

NPI: 1528088903
Provider Name (Legal Business Name): FELIX C. MADRID D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 SOUTHERN BLVD SE STE B1
RIO RANCHO NM
87124-3761
US

IV. Provider business mailing address

10905 FAROLA DR NW
ALBUQUERQUE NM
87114-6501
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-0111
  • Fax:
Mailing address:
  • Phone: 505-899-5833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDD1864
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: