Provider Demographics
NPI:1700115078
Name:ALBUQUERQUE EMERGENCY DENTAL CARE USA, INC
Entity Type:Organization
Organization Name:ALBUQUERQUE EMERGENCY DENTAL CARE USA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:OBENG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-597-1186
Mailing Address - Street 1:1338 N 143RD AVENUE CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-5108
Mailing Address - Country:US
Mailing Address - Phone:402-597-1186
Mailing Address - Fax:402-597-3643
Practice Address - Street 1:10820 COMANCHE RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3983
Practice Address - Country:US
Practice Address - Phone:505-296-9911
Practice Address - Fax:505-332-9118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty