1376275818 NPI number — SUCCESS SMILES ORTHODONTICS SANTA FE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376275818 NPI number — SUCCESS SMILES ORTHODONTICS SANTA FE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUCCESS SMILES ORTHODONTICS SANTA FE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376275818
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8216 LOUISIANA BLVD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87113-2105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-569-6639
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 KIVA CT STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87505-6123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-569-6639
Provider Business Practice Location Address Fax Number:
505-666-5513
Provider Enumeration Date:
06/24/2022

Additional Information

Authorized Official

Authorized Official Last Name:
PADILLA
Authorized Official First Name:
LIGIA
Authorized Official Middle Name:
ELENA
Authorized Official Title or Position:
ORTHODONTIST
Authorized Official Telephone Number:
505-569-6639

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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