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General NPI Number Information
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NPI Number | 1851182612
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Entity Type | Organization
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Legal Business Name | MOUNTAIN VIEW PEDIATRIC DENTISTRY LLC
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 1904 WELLSPRING AVE SE STE 105
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City | RIO RANCHO
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State | NM
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Zip | 87124-4888
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Country | US
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Telephone | 505-415-0462
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Fax |
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Provider Business Mailing Address
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Address Line | 1574 LAKELAND GRV APT 103
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City | MONUMENT
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State | CO
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Zip | 80132-6264
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Country | US
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Telephone | 505-377-9909
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | JENNIFER ARCHULETA
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Credential |
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Telephone | 505-377-9909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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