Organization
OPEN WIDE DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDRA LEE KEANNA (OWNER)
(505) 292-8533
Entity
Organization
Contact information
Practice address
1100 LEAD AVE SE, ALBUQUERQUE, NM 87106
(505) 292-8533
(505) 292-2712
Mailing address
1100 LEAD AVE SE, ALBUQUERQUE, NM 87106-5215
(505) 292-8533
(505) 292-2712
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
09/25/2008
Last updated
09/25/2008
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