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Organization
ALBUQUERQUE WEST SMILES YOUTH DENTISTRY, PC
Active
Organization
ALBUQUERQUE WEST SMILES YOUTH DENTISTRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM FREEMAN (REGIONAL MANAGER)
(505) 377-9911
Entity
Organization
Contact information
Practice address
111 COORS BLVD NW, E-6, ALBUQUERQUE, NM 87121-2006
(505) 352-3808
(505) 352-3811
Mailing address
111 COORS BLVD NW STE E6, ALBUQUERQUE, NM 87121-2009
(505) 352-3808
(505) 352-3811
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77532
—
NM
Enumeration date
05/05/2006
Last updated
09/30/2014
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