Provider Demographics
NPI:1083172522
Name:ABQ UPTOWN DENTISTS LLC
Entity Type:Organization
Organization Name:ABQ UPTOWN DENTISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GAYLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:REACHI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:505-301-6688
Mailing Address - Street 1:7127 PROSPECT PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4313
Mailing Address - Country:US
Mailing Address - Phone:505-881-4365
Mailing Address - Fax:505-214-6905
Practice Address - Street 1:7127 PROSPECT PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4313
Practice Address - Country:US
Practice Address - Phone:505-881-4365
Practice Address - Fax:505-214-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty