Organization
ABQ MODERN DENTAL GROUP, LLC
Active
Other names
ABQ Modern Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
KELLEY HOLLINGSWORTH RYALS DDS (OWNER DENTIST)
(505) 323-1004
Entity
Organization
Contact information
Practice address
12611 MONTGOMERY BLVD NE, A-1, ALBUQUERQUE, NM 87111-4118
(505) 323-1004
(505) 323-4355
Mailing address
17000 RED HILL AVE, IRVINE, CA 92614-5626
(714) 845-8890
(949) 474-1495
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/11/2015
Last updated
06/11/2015
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