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General NPI Number Information
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NPI Number | 1891372389
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Entity Type | Organization
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Legal Business Name | CRANIOFACIAL SLEEP MEDICINE AND TMJ OF NEW MEXICO, LLC
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 8311 SAN PEDRO DR NE STE 3
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-2540
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Country | US
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Telephone | 505-433-2107
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Fax | 505-508-2674
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Provider Business Mailing Address
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Address Line | 8311 SAN PEDRO DR NE STE 3
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-2540
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Country | US
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Telephone | 505-433-2107
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Fax | 505-508-2674
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. ERIC J COONTZ
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Credential | DDS,MS
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Telephone | 505-433-2107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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