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Organization

TRUCARE MOBILE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SUNIL KUMAR GUDDETI DMD (DENTIST)
(505) 903-6999
Entity
Organization

Contact information

Practice address
1510 WYOMING BLVD NE STE A, ALBUQUERQUE, NM 87112-3866
(505) 903-6999
Mailing address
1510 WYOMING BLVD NE STE A, ALBUQUERQUE, NM 87112-3866

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD4236
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
54501334
NM
Enumeration date
07/11/2016
Last updated
07/11/2016
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