Provider Demographics
NPI:1174632350
Name:COMMUNITY DENTAL SERVICES, INC.
Entity Type:Organization
Organization Name:COMMUNITY DENTAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-843-7493
Mailing Address - Street 1:2116 HINKLE ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-4930
Mailing Address - Country:US
Mailing Address - Phone:505-843-7493
Mailing Address - Fax:505-843-7581
Practice Address - Street 1:2116 HINKLE ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-4930
Practice Address - Country:US
Practice Address - Phone:505-843-7493
Practice Address - Fax:505-843-7581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM47506Medicaid
NM85831Medicaid
NM87703Medicaid