Provider Demographics
NPI:1578148474
Name:DENTAL TRIBE NE ABQ LLC
Entity Type:Organization
Organization Name:DENTAL TRIBE NE ABQ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:RODAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-987-0101
Mailing Address - Street 1:3520 MONTGOMERY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4846
Mailing Address - Country:US
Mailing Address - Phone:505-888-2606
Mailing Address - Fax:505-837-1635
Practice Address - Street 1:3520 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4846
Practice Address - Country:US
Practice Address - Phone:505-888-2606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental