Provider Demographics
NPI:1346896958
Name:KPU DENTAL LLC
Entity Type:Organization
Organization Name:KPU DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATARZYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:UJDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-982-9222
Mailing Address - Street 1:2019 GALISTEO ST STE L2
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2112
Mailing Address - Country:US
Mailing Address - Phone:505-982-9222
Mailing Address - Fax:505-982-7114
Practice Address - Street 1:2019 GALISTEO ST STE L2
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2112
Practice Address - Country:US
Practice Address - Phone:505-982-9222
Practice Address - Fax:505-982-7114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-11
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMDD3665OtherDENTAL LICENSE