Provider Demographics
NPI:1164650388
Name:FELIX C. MADRID, D.D.S.,P.A.
Entity Type:Organization
Organization Name:FELIX C. MADRID, D.D.S.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:C
Authorized Official - Last Name:MADRID
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-892-0111
Mailing Address - Street 1:2345 SOUTHERN BLVD SE
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3760
Mailing Address - Country:US
Mailing Address - Phone:505-892-0111
Mailing Address - Fax:505-994-1004
Practice Address - Street 1:2345 SOUTHERN BLVD SE
Practice Address - Street 2:SUITE B-1
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3760
Practice Address - Country:US
Practice Address - Phone:505-892-0111
Practice Address - Fax:505-994-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD1864122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM3272/109077Medicaid