# NEW MEXICO PROFESSIONAL DENTAL ASSOCIATES, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NEW MEXICO PROFESSIONAL DENTAL ASSOCIATES, INC
- **Other names:** Alegre Dental @ Petroglyphs
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1366837643
- **Legal business name:** NEW MEXICO PROFESSIONAL DENTAL ASSOCIATES, INC
- **Authorized official:** KIM WILSON (CRED SUPERVISOR)
- **Authorized official phone:** (217) 540-5170

## Contact information

- **Practice address:** 2116 VISTA OESTE NW STE 202, ALBUQUERQUE, NM 87120-4341
- **Practice address phone:** (505) 836-1076
- **Practice address fax:** (505) 836-9809
- **Mailing address:** 2116 VISTA OESTE NW STE 202, ALBUQUERQUE, NM 87120-4341
- **Mailing address phone:** (505) 836-1076
- **Mailing address fax:** (505) 836-9809

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 04/02/2015
- **Last updated:** 04/02/2015