Organization
SUNRIDGE DENTAL CARE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER ROUKEMA D.M.D. (PRESIDENT)
(505) 836-0322
Entity
Organization
Contact information
Practice address
6400 CENTRAL AVE SW, ALBUQUERQUE, NM 87105-2033
(505) 836-0322
Mailing address
6400 CENTRAL AVE SW, ALBUQUERQUE, NM 87105-2033
(505) 836-0322
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD3069
NM
Other
Enumeration date
11/16/2010
Last updated
11/16/2010
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