Organization
BEAR CANYON FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARISSA J GREINEL-BLUM DDS (OWNER)
(505) 821-1430
Entity
Organization
Contact information
Practice address
7007 WYOMING BLVD NE STE B2, ALBUQUERQUE, NM 87109-3982
(505) 821-1430
(505) 821-1442
Mailing address
7007 WYOMING BLVD NE STE B2, ALBUQUERQUE, NM 87109-3982
(505) 821-1430
(505) 821-1442
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DD2155
NM
1223G0001X
General Practice Dentistry
DD3003
NM
1223G0001X
General Practice Dentistry
Primary
DD3005
NM
Other
Enumeration date
10/16/2013
Last updated
10/16/2013
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