Provider Demographics
NPI:1083748016
Name:KID'S CHOICE DENTAL, INC
Entity Type:Organization
Organization Name:KID'S CHOICE DENTAL, INC
Other - Org Name:FAMILY CHOICE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NOYES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-352-5439
Mailing Address - Street 1:120 98TH ST NW STE C3
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-9021
Mailing Address - Country:US
Mailing Address - Phone:505-352-5439
Mailing Address - Fax:505-836-7533
Practice Address - Street 1:120 98TH ST NW STE C3
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-9021
Practice Address - Country:US
Practice Address - Phone:505-352-5439
Practice Address - Fax:505-836-7533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD25231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM57459568Medicaid
PA1768244OtherUNITED CONCORDIA GROUP #