Individual
KENNETH DORSEY TISDALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.C.I.C.I., LMT #548
Contact information
Practice address
201 EUBANK BLVD NE, B1, ALBUQUERQUE, NM 87123
(505) 712-7585
Mailing address
8400 MENAUL BLVD, 8400 MENAUL BLVD. NE. #217, ALBUQUERQUE, NM 87112
(505) 712-7585
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
LMT # 5488
NM
Other
Enumeration date
02/28/2011
Last updated
02/28/2011
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