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General NPI Number Information
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NPI Number | 1316485741
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Entity Type | Organization
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Legal Business Name | PARADISE HILLS FAMILY DENTAL
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 8201 GOLF COURSE RD NW, C-3
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City | ALBUQUERQUE
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State | NM
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Zip | 87120
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Country | US
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Telephone | 505-200-0187
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Fax |
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Provider Business Mailing Address
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Address Line | 717 ENCINO PL NE, STE 6
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City | ALBUQUERQUE
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State | NM
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Zip | 87102
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Country | US
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Telephone | 505-200-0187
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAPIL GREWAL
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Credential | DDS
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Telephone | 505-200-0187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4182
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License Number State | NM
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