Provider Demographics
NPI:1437654837
Name:AU CROWN ENTERPRISES LLC
Entity Type:Organization
Organization Name:AU CROWN ENTERPRISES LLC
Other - Org Name:CARABELLI DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEON
Authorized Official - Middle Name:
Authorized Official - Last Name:AHGHAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-553-1332
Mailing Address - Street 1:824 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-4969
Mailing Address - Country:US
Mailing Address - Phone:575-622-4455
Mailing Address - Fax:
Practice Address - Street 1:824 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4969
Practice Address - Country:US
Practice Address - Phone:575-622-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD42751223G0001X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty