Individual
JULIET V SMITH-EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 COORS BLVD NW, E-6, ALBUQUERQUE, NM 87121-2006
(505) 352-3808
Mailing address
415 N GRAND AVE, PUEBLO, CO 81003-3111
(719) 583-1800
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD2550
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0015438
DORAL
NM
05
—
59325771
—
NM
01
—
961058
UNITED CONCORDIA
NM
Enumeration date
01/26/2007
Last updated
07/09/2007
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