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General NPI Number Information
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NPI Number | 1184082125
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Entity Type | Organization
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Legal Business Name | ENCINO DENTAL CARE, INC.
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Dates
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Enumeration Date | 02/05/2016
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Last Update Date | 02/05/2016
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Provider Practice Location Address
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Address Line | 717 ENCINO PL NE SUITE 7
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2611
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Country | US
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Telephone | 505-843-9636
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Fax | 505-843-6277
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Provider Business Mailing Address
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Address Line | 717 ENCINO PL NE SUITE 7
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2611
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Country | US
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Telephone | 505-843-9636
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Fax | 505-843-6277
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHILLIP RICHARDSON
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Credential | CPDH, DOM
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Telephone | 505-843-9636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH 812
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License Number State | NM
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