Organization
PEPPERMINT DENTAL-RIO BRAVO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY PU (CFO)
(972) 869-3789
Entity
Organization
Contact information
Practice address
3211 COORS BLVD SW, SUITE D-2, ALBUQUERQUE, NM 87121-5254
(972) 869-3789
Mailing address
7301 STATE HIGHWAY 161, SUITE 198, IRVING, TX 75039-2816
(972) 869-3789
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
12/30/2010
Last updated
12/30/2010
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