Provider Demographics
NPI:1851016125
Name:SOUTHWEST DENTAL
Entity Type:Organization
Organization Name:SOUTHWEST DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:RANJBARAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-908-6110
Mailing Address - Street 1:1137 COMMERCIAL DR SE STE 103
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4658
Mailing Address - Country:US
Mailing Address - Phone:505-896-9399
Mailing Address - Fax:
Practice Address - Street 1:1137 COMMERCIAL DR SE STE 103
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4658
Practice Address - Country:US
Practice Address - Phone:505-896-9399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental