Provider Demographics
NPI:1164694287
Name:COTTONWOOD ORTHODONTICS, PC
Entity Type:Organization
Organization Name:COTTONWOOD ORTHODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:TORREBIARTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-766-4800
Mailing Address - Street 1:3730 ELLISON RD NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-7009
Mailing Address - Country:US
Mailing Address - Phone:505-766-4800
Mailing Address - Fax:505-898-5270
Practice Address - Street 1:3730 ELLISON RD NW
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-7009
Practice Address - Country:US
Practice Address - Phone:505-766-4800
Practice Address - Fax:505-898-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD19851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0009084Medicaid
NM1124096995OtherINDIVIDUAL NPI FOR DOCTOR