=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730358003
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CABEZON DENTAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2008
-----------------------------------------------------
Last Update Date | 02/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2401 CABEZON RD
-----------------------------------------------------
City | RIO RANCHO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-450-2409
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4308 BERESFORD LN NW
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87120-4661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-450-2799
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. HONG MINH MORRISON
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 505-459-2799
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DD2512
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------