# PERFECT TEETH - FOURTH STREET P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Perfect Teeth - Fourth Street P.C.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336260769
- **Authorized official:** LAURIE SUMMERS (CREDENTIALING)
- **Authorized official phone:** (303) 285-6098

## Contact information

- **Practice address:** 5721 4TH ST NW, ALBUQUERQUE, NM 87107-5302
- **Practice address phone:** (505) 345-0515
- **Practice address fax:** (505) 345-2418
- **Mailing address:** 5721 4TH ST NW, ALBUQUERQUE, NM 87107-5302
- **Mailing address phone:** (505) 345-0515
- **Mailing address fax:** (505) 345-2418

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 1398 | NM | Yes |

## Other

- **Enumeration date:** 04/03/2007
- **Last updated:** 08/22/2020