Provider Demographics
NPI:1952027146
Name:LRJ DENTAL LLC
Entity Type:Organization
Organization Name:LRJ DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KINNARI
Authorized Official - Middle Name:
Authorized Official - Last Name:JARIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-835-4622
Mailing Address - Street 1:601 MENAUL BLVD NE UNIT 1303
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1571
Mailing Address - Country:US
Mailing Address - Phone:505-453-0637
Mailing Address - Fax:
Practice Address - Street 1:8311 SAN PEDRO DR NE STE 3
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2540
Practice Address - Country:US
Practice Address - Phone:505-433-2107
Practice Address - Fax:505-508-2674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic