# ALBUQUERQUE WEST SMILES YOUTH DENTISTRY, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730137217
- **Authorized official:** MRS. KIM FREEMAN (REGIONAL MANAGER)
- **Authorized official phone:** (505) 377-9911

## Contact information

- **Practice address:** 111 COORS BLVD NW, E-6, ALBUQUERQUE, NM 87121-2006
- **Practice address phone:** (505) 352-3808
- **Practice address fax:** (505) 352-3811
- **Mailing address:** 111 COORS BLVD NW STE E6, ALBUQUERQUE, NM 87121-2009
- **Mailing address phone:** (505) 352-3808
- **Mailing address fax:** (505) 352-3811

## Taxonomy

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

## Other

- **Enumeration date:** 05/05/2006
- **Last updated:** 09/30/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 77532 | — | NM |