Organization
PUEBLO OF ISLETA
Active
Other names
Pueblo of Isleta Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VOLELLE K ZAMORA (CEO)
(505) 869-4094
Entity
Organization
Contact information
Practice address
01 SAGEBRUSH RD, ISLETA, NM 87022-0000
(505) 869-4863
Mailing address
01 SAGEBRUSH RD, ISLETA, NM 87022-0000
(505) 869-4863
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
501C
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
55528309
—
NM
Enumeration date
03/30/2007
Last updated
05/17/2017
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