Organization
ALBUQUERQUE I.H.S. DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MAUREEN R. CORDOVA (CHIEF EXECUTIVE OFFICER)
(505) 922-4248
Entity
Organization
Contact information
Practice address
9169 COORS ROAD, NW, ALBUQUERQUE, NM 87120
(505) 346-2306
Mailing address
P.O. BOX 67830, ALBUQUERQUE, NM 87193
(505) 346-2306
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
846024
—
AZ
05
—
89730
—
NM
Enumeration date
10/03/2006
Last updated
08/22/2020
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