Organization
ALBUQUERQUE WEST SMILES YOUTH DENTISTRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM FREEMAN (REGIONAL MANAGER)
(505) 377-9911
Entity
Organization
Contact information
Practice address
111 COORS BLVD NW, E-6, ALBUQUERQUE, NM 87121-2006
(505) 352-3808
(505) 352-3811
Mailing address
111 COORS BLVD NW STE E6, ALBUQUERQUE, NM 87121-2009
(505) 352-3808
(505) 352-3811
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77532
—
NM
Enumeration date
05/05/2006
Last updated
09/30/2014
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