Provider Demographics
NPI:1750835583
Name:AFFORDABLE DENTURES - ALBUQUERQUE, P.C.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES - ALBUQUERQUE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HERRON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:505-345-2100
Mailing Address - Street 1:4821 ALEXANDER BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6820
Mailing Address - Country:US
Mailing Address - Phone:505-345-2100
Mailing Address - Fax:
Practice Address - Street 1:4821 ALEXANDER BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-6820
Practice Address - Country:US
Practice Address - Phone:505-345-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2568122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty