Individual
DR. STEPHEN R MACKIW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., P.C.
Contact information
Practice address
3900 EUBANK BLVD NE, SUITE 4, ALBUQUERQUE, NM 87111-3465
(505) 298-6732
(505) 275-9976
Mailing address
3900 EUBANK BLVD NE, SUITE 4, ALBUQUERQUE, NM 87111-3465
(505) 298-6732
(505) 275-9976
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD2476
NM
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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