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General NPI Number Information
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NPI Number | 1811321003
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Entity Type | Individual
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Provider Name | SUNEEL KUMAR NAMBURI DMD
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Gender | Male
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Dates
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Enumeration Date | 08/24/2013
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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 | 630-730-9676
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Fax |
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Provider Business Mailing Address
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Address Line | 85 W HWY 22
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City | SANTO DOMINGO PUEBLO
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State | NM
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Zip | 87052
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Country | US
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Telephone | 630-730-9676
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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