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Organization
PUEBLO OF ISLETA
Active
Organization
PUEBLO OF ISLETA
Active
Other names
Pueblo of Isleta Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY POHL (CEO)
(505) 869-3200
Entity
Organization
Contact information
Practice address
01 SAGEBRUSH RD, ISLETA, NM 87022-0000
(505) 869-4863
Mailing address
01 SAGEBRUSH RD, ISLETA, NM 87022-0000
(505) 869-4863
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
501C
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
55528309
—
NM
Enumeration date
03/30/2007
Last updated
08/19/2026
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