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General NPI Number Information
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NPI Number | 1750835583
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Entity Type | Organization
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Legal Business Name | AFFORDABLE DENTURES - ALBUQUERQUE, P.C.
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Dates
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Enumeration Date | 08/10/2016
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Last Update Date | 08/10/2016
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Provider Practice Location Address
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Address Line | 4821 ALEXANDER BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-6820
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Country | US
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Telephone | 505-345-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 4821 ALEXANDER BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-6820
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Country | US
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Telephone | 505-345-2100
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | GARY R HERRON II
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Credential |
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Telephone | 505-345-2100
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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 | DD2568
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License Number State | NM
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