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General NPI Number Information
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NPI Number | 1497849186
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Entity Type | Organization
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Legal Business Name | ALBUQUERQUE I.H.S. DENTAL CLINIC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9169 COORS ROAD, NW
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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 | 505-346-2306
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 67830
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City | ALBUQUERQUE
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State | NM
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Zip | 87193
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Country | US
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Telephone | 505-346-2306
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. MAUREEN R. CORDOVA
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Credential |
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Telephone | 505-922-4248
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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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