Provider Demographics
NPI:1134289838
Name:PARTICIPA, INC. DENTAL SERVICES
Entity Type:Organization
Organization Name:PARTICIPA, INC. DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:T
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:800-886-6751
Mailing Address - Street 1:2434 VALENCIA DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4013
Mailing Address - Country:US
Mailing Address - Phone:800-886-6751
Mailing Address - Fax:800-886-6751
Practice Address - Street 1:2434 VALENCIA DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4013
Practice Address - Country:US
Practice Address - Phone:800-886-6751
Practice Address - Fax:800-886-6751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD14321223D0001X
NMDD6291223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM73799Medicaid