Organization
ALBUQUERQUE EAST 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
201 SAN PEDRO DR SE, SUITE B-2, ALBUQUERQUE, NM 87108-3009
(505) 232-5437
(505) 254-7649
Mailing address
201 SAN PEDRO DR SE STE B2, ALBUQUERQUE, NM 87108-3009
(505) 232-5437
(505) 254-7649
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
93175027
—
NM
Enumeration date
05/07/2006
Last updated
09/30/2014
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