MEDICARE: UTOPIA DENTAL CARE

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	124Q00000X	Dental Hygienist

General Provider Information

NPI Number	:	1588085195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UTOPIA DENTAL CARE

Provider Business Mailing Address
First Line	:	901 RIO GRANDE BLVD NW
Second Line	:	154G
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-2057
Country	:	US
Telephone Number	:	505-363-3435
Fax Number	:	505-899-6192

Provider Business Practice Location Address
First Line	:	901 RIO GRANDE BLVD NW
Second Line	:	154G
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-2057
Country	:	US
Telephone Number	:	505-363-3435
Fax Number	:	505-899-6192

Authorized Official
Title or Position	:	DENTAL HYGIENIST
Name	:	MRS. DARLY GERMAIN BARKLEY
Credential	:	RDH
Telephone Number	:	505-363-3435

Provider Enumeration Date	:	12/27/2013
Last Update Date	:	12/27/2013

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