Provider Demographics
NPI:1265671770
Name:SANDIA ORAL SURGERY AND DENTAL IMPLANT CENTER
Entity Type:Organization
Organization Name:SANDIA ORAL SURGERY AND DENTAL IMPLANT CENTER
Other - Org Name:DAVID ERIC TUGGLE DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:TUGGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-291-9600
Mailing Address - Street 1:7009 MONTGOMERY BLVD. NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109
Mailing Address - Country:US
Mailing Address - Phone:505-291-9600
Mailing Address - Fax:505-299-5280
Practice Address - Street 1:7009 MONTGOMERY BLVD. NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-291-9600
Practice Address - Fax:505-299-5280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-08
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD 30871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty