Provider Demographics
NPI:1215544432
Name:CORONADO FAMILY DENTAL
Entity Type:Organization
Organization Name:CORONADO FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIEM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-369-6451
Mailing Address - Street 1:11130 LOMAS BLVD NE STE F2
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5581
Mailing Address - Country:US
Mailing Address - Phone:505-369-6451
Mailing Address - Fax:
Practice Address - Street 1:11130 LOMAS BLVD NE STE F2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5581
Practice Address - Country:US
Practice Address - Phone:505-369-6451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-01
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental