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General NPI Number Information
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NPI Number | 1184435521
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Entity Type | Organization
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Legal Business Name | FC 120 98TH LLC
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 120 98TH ST NW STE C3
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City | ALBUQUERQUE
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State | NM
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Zip | 87121-9021
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Country | US
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Telephone | 830-347-1844
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Fax |
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Provider Business Mailing Address
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Address Line | 120 98TH ST NW STE C3
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City | ALBUQUERQUE
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State | NM
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Zip | 87121-9021
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Country | US
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Telephone | 830-347-1844
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Fax |
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Authorized Official
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Title or Position | COO
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Name | AISHA WILLIAMS
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Credential |
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Telephone | 830-347-1844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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