Provider Demographics
NPI:1376215731
Name:NEW MEXICO DENTISTRY PRADA, PLLC
Entity Type:Organization
Organization Name:NEW MEXICO DENTISTRY PRADA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF PAYER RELATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:THACKER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:702-291-2031
Mailing Address - Street 1:2250 S RANCHO DR STE 205
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-4456
Mailing Address - Country:US
Mailing Address - Phone:702-291-2031
Mailing Address - Fax:702-984-7566
Practice Address - Street 1:6211 4TH ST NW STE 1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-5700
Practice Address - Country:US
Practice Address - Phone:702-291-2031
Practice Address - Fax:702-984-7566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty