Organization
UPTOWN PARK DENTAL PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN MAXEY (BUSINESS MANAGER)
(303) 789-5224
Entity
Organization
Contact information
Practice address
2100 LOUISIANA BLVD NE, SUITE 104, ALBUQUERQUE, NM 87110-5419
(505) 883-4867
(505) 883-4007
Mailing address
2100 LOUISIANA BLVD NE, SUITE 104, ALBUQUERQUE, NM 87110-5419
(505) 883-4867
(505) 883-4007
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0973127
UNITED CONCORIDA
NM
Enumeration date
05/08/2008
Last updated
04/30/2019
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