Organization
AAA DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERICA L CASTILLO (MANAGER)
(505) 554-2262
Entity
Organization
Contact information
Practice address
3803 ATRISCO DR NW, STE-D, ALBUQUERQUE, NM 87120-4956
(505) 833-1550
Mailing address
800 JUAN TABO BLVD NE, STE-Q, ALBUQUERQUE, NM 87123-1444
(505) 554-2697
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD3595
NM
1223G0001X
General Practice Dentistry
DD4343
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32284756
—
NM
05
—
54001871
—
NM
Enumeration date
04/21/2017
Last updated
04/21/2017
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