Provider Demographics
NPI:1871042457
Name:DENTAL HOUSE TRADE WINDS, LLC
Entity Type:Organization
Organization Name:DENTAL HOUSE TRADE WINDS, LLC
Other - Org Name:DENTAL HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-508-1118
Mailing Address - Street 1:7930 WYOMING BLVD NE STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6019
Mailing Address - Country:US
Mailing Address - Phone:505-508-1118
Mailing Address - Fax:
Practice Address - Street 1:7930 WYOMING BLVD NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6019
Practice Address - Country:US
Practice Address - Phone:505-508-1118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-24
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental