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
Update your record
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