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General NPI Number Information
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NPI Number | 1356027858
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Entity Type | Organization
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Legal Business Name | SIGNATURE NEW MEXICO DENTAL PARTNERS
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Dates
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Enumeration Date | 06/27/2023
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 3900 EUBANK BLVD NE STE 14
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3427
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Country | US
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Telephone | 505-293-8011
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Fax |
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Provider Business Mailing Address
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Address Line | 410 N 44TH ST STE 290
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City | PHOENIX
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State | AZ
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Zip | 85008-7622
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Country | US
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Telephone | 480-234-8490
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF INTEGRATIONS
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Name | MELODY BENNION
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Credential |
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Telephone | 480-234-8490
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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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