Provider Demographics
NPI: | 1932653458 |
---|---|
Name: | DENTAL PARTNER'S OF RIO RANCHO, LLC |
Entity Type: | Organization |
Organization Name: | DENTAL PARTNER'S OF RIO RANCHO, LLC |
Other - Org Name: | COMFORT DENTAL OF RIO RANCHO, LLC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MEMBER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JEFF |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GREENE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 505-400-3739 |
Mailing Address - Street 1: | 2003 SOUTHERN BLVD SE |
Mailing Address - Street 2: | SUITE 133 & 134 |
Mailing Address - City: | ALBUQUERQUE |
Mailing Address - State: | NM |
Mailing Address - Zip Code: | 87124-3751 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 505-221-5740 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2003 SOUTHERN BLVD SE |
Practice Address - Street 2: | SUITE 133 & 134 |
Practice Address - City: | ALBUQUERQUE |
Practice Address - State: | NM |
Practice Address - Zip Code: | 87124-3751 |
Practice Address - Country: | US |
Practice Address - Phone: | 505-221-5740 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-08-12 |
Last Update Date: | 2016-08-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Single Specialty |