MEDICARE: SANTA FE CHILDREN'S DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1386056737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA FE CHILDREN'S DENTISTRY

Provider Business Mailing Address
First Line	:	8201 GOLF COURSE RD NW
Second Line	:	SUITE C-3
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-5842
Country	:	US
Telephone Number	:	505-892-9010
Fax Number	:

Provider Business Practice Location Address
First Line	:	2008 SAINT MICHAELS DR
Second Line	:	SUITE B
City	:	SANTA FE
State	:	NM
Zip	:	87505-7682
Country	:	US
Telephone Number	:	505-892-9010
Fax Number	:	505-899-4804

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JAMES TASKER
Credential	:
Telephone Number	:	505-892-9010

Provider Enumeration Date	:	05/20/2014
Last Update Date	:	05/21/2014

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Practice Location Address:

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Practice Location Address:

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1104991538 — PATRICK J MCQUITTY
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1972805349 — PHILIP TREU OD PC
Practice Location Address:

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Directions to “SANTA FE CHILDREN'S DENTISTRY ” Practice Location

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