Provider Demographics
NPI:1073113197
Name:ARAGON PEDIATRIC DENTISTRY LLC
Entity Type:Organization
Organization Name:ARAGON PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:505-610-4531
Mailing Address - Street 1:8300 CARMEL AVE NE STE 60
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-3147
Mailing Address - Country:US
Mailing Address - Phone:505-878-0700
Mailing Address - Fax:
Practice Address - Street 1:8300 CARMEL AVE NE STE 60
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-3147
Practice Address - Country:US
Practice Address - Phone:505-878-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty