MEDICARE: PERFECT TEETH - FOUR HILLS P.C.

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	1223G0001X	General Practice Dentistry	1398	NM

General Provider Information

NPI Number	:	1427179852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFECT TEETH - FOUR HILLS P.C.

Provider Business Mailing Address
First Line	:	13140 CENTRAL AVE SE STE E
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87123-5547
Country	:	US
Telephone Number	:	505-292-3323
Fax Number	:	505-292-7327

Provider Business Practice Location Address
First Line	:	13140 CENTRAL AVE SE STE E
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87123-5547
Country	:	US
Telephone Number	:	505-292-3323
Fax Number	:	505-292-7327

Authorized Official
Title or Position	:	DIRECTOR, RCM
Name	:	LAUREN HILL
Credential	:
Telephone Number	:	972-930-7707

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	08/30/2022

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