Healthcare Provider Details

I. General information

NPI: 1346896958
Provider Name (Legal Business Name): KPU DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2019
Last Update Date: 08/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST STE L2
SANTA FE NM
87505-2112
US

IV. Provider business mailing address

2019 GALISTEO ST STE L2
SANTA FE NM
87505-2112
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-9222
  • Fax: 505-982-7114
Mailing address:
  • Phone: 505-982-9222
  • Fax: 505-982-7114

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: DR. KATARZYNA UJDA
Title or Position: DENTIST OWNER
Credential: DDS
Phone: 505-982-9222