Organization
NEW MEXICO PROFESSIONAL DENTAL ASSOCIATES, INC
Active
Parent organization
NEW MEXICO PROFESSIONAL DENTAL ASSOCIATES, INC
Other names
Alegre Dental @ Petroglyphs
Organization subpart
Yes
Provider details
NPI number
Legal business name
NEW MEXICO PROFESSIONAL DENTAL ASSOCIATES, INC
Authorized official
KIM WILSON (CRED SUPERVISOR)
(217) 540-5170
Entity
Organization
Contact information
Practice address
2116 VISTA OESTE NW STE 202, ALBUQUERQUE, NM 87120-4341
(505) 836-1076
(505) 836-9809
Mailing address
2116 VISTA OESTE NW STE 202, ALBUQUERQUE, NM 87120-4341
(505) 836-1076
(505) 836-9809
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/02/2015
Last updated
04/02/2015
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