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General NPI Number Information
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NPI Number | 1356705305
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Entity Type | Organization
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Legal Business Name | DR. DENTAL OF NEW MEXICO
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 800 JUAN TABO BLVD NE STE Q
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-1444
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Country | US
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Telephone | 505-554-2262
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Fax | 505-554-2697
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Provider Business Mailing Address
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Address Line | 800 JUAN TABO BLVD NE STE Q
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-1444
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Country | US
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Telephone | 505-554-2262
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Fax | 505-554-2697
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SUNEEL KUMAR NAMBURI
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Credential | DMD
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Telephone | 630-730-9676
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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 | DD4343
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License Number State | NM
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