Provider Demographics
NPI:1881825214
Name:ALICIA A. ABEYTA DDS LLC
Entity Type:Organization
Organization Name:ALICIA A. ABEYTA DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABEYTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-293-7611
Mailing Address - Street 1:4830 JUAN TABO BLVD NE STE K
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2682
Mailing Address - Country:US
Mailing Address - Phone:505-293-7611
Mailing Address - Fax:
Practice Address - Street 1:4830 JUAN TABO BLVD NE STE K
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2682
Practice Address - Country:US
Practice Address - Phone:505-293-7611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2626122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty