# GREAT WHITE DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Isham Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639663792
- **Authorized official:** DR. MICHAEL SCOTT ISHAM DMD (OWNER/DENTIST)
- **Authorized official phone:** (505) 881-0422

## Contact information

- **Practice address:** 5555 MONTGOMERY BLVD NE STE 17, ALBUQUERQUE, NM 87109-1445
- **Practice address phone:** (505) 881-0422
- **Mailing address:** 5555 MONTGOMERY BLVD NE STE 17, ALBUQUERQUE, NM 87109-1445
- **Mailing address phone:** (505) 881-0422

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DD4733 | NM | Yes |

## Other

- **Enumeration date:** 06/21/2018
- **Last updated:** 06/21/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 48108588 | — | NM |