Provider Demographics
NPI:1154686012
Name:DENTAL PARTNERS OF LOMAS
Entity Type:Organization
Organization Name:DENTAL PARTNERS OF LOMAS
Other - Org Name:COMFORT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS REP
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-232-2273
Mailing Address - Street 1:4701 LOMAS BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6233
Mailing Address - Country:US
Mailing Address - Phone:505-232-2273
Mailing Address - Fax:505-255-2990
Practice Address - Street 1:4701 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6233
Practice Address - Country:US
Practice Address - Phone:505-232-2273
Practice Address - Fax:505-255-2990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD34441223G0001X
NMDD32691223G0001X
NMDD32421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM=========Medicaid