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General NPI Number Information
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NPI Number | 1760671705
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Entity Type | Organization
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Legal Business Name | NEW MEXICO ENDODONTIC SPECIALISTS, PC
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 10151 MONTGOMERY BLVD NE STE 2B
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3664
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Country | US
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Telephone | 505-830-3636
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Fax | 505-830-2305
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Provider Business Mailing Address
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Address Line | 10151 MONTGOMERY BLVD NE STE 2B
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3664
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Country | US
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Telephone | 505-830-3636
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Fax | 505-830-2305
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN JENKINS
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Credential | DDS
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Telephone | 505-830-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 1137
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 2173
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License Number State | NM
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