Organization
TRUCARE DENTAL WYOMING BLVD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA PATTERSON DDS (PRESIDENT)
(505) 369-0074
Entity
Organization
Contact information
Practice address
1510 WYOMING BLVD NE STE A, ALBUQUERQUE, NM 87112-3866
(505) 369-0074
Mailing address
1510 WYOMING BLVD NE STE A, ALBUQUERQUE, NM 87112-3866
(505) 369-0074
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD3577
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
57279047
—
NM
Enumeration date
10/08/2015
Last updated
10/08/2015
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