=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992338826
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AHH DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2020
-----------------------------------------------------
Last Update Date | 02/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4041 CERRILLOS RD
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87507-2916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-438-3276
-----------------------------------------------------
Fax | 505-780-8178
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4041 CERRILLOS RD
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87507-2916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-438-3276
-----------------------------------------------------
Fax | 505-780-8178
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/CEO
-----------------------------------------------------
Name | DR. SYLVIA RENAE MORESCHINI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 505-438-3276
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------