Cottonwood Mall Dental Practice, LLC
Clinic/Center, Dental in Albuquerque, NM. Organization (NPI-2).
NPI number1043487119
StatusActive
Last updated in NPPESApr 30, 2019
Details
- NPI
- 1043487119
- Entity type
- Organization (NPI-2)
- Legal business name
- Cottonwood Mall Dental Practice, LLC
- Organization subpart
- No
- Enumeration date
- May 8, 2008
- Last updated
- Apr 30, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
10000 Coors Byp Nw# G-218
Albuquerque, NM 87114-4040
Phone 505-242-4867 · Fax 505-890-2883
Mailing address
10000 Coors Byp Nw# G-218
Albuquerque, NM 87114-4040
Phone 505-242-4867 · Fax 505-890-2883
Authorized official
William A. Sapp
President
5052424867
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