Organization
COTTONWOOD MALL DENTAL PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM A. SAPP DDS (PRESIDENT)
(505) 242-4867
Entity
Organization
Contact information
Practice address
10000 COORS BYP NW, # G-218, ALBUQUERQUE, NM 87114-4040
(505) 242-4867
(505) 890-2883
Mailing address
10000 COORS BYP NW, # G-218, ALBUQUERQUE, NM 87114-4040
(505) 242-4867
(505) 890-2883
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1440525
UNITED CONCORDIA
NM
Enumeration date
05/08/2008
Last updated
04/30/2019
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