1932653458 NPI number — DENTAL PARTNER'S OF RIO RANCHO, LLC

Table of content: KAILA NICOLE KILLIAN DPT (NPI 1982273025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932653458 NPI number — DENTAL PARTNER'S OF RIO RANCHO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL PARTNER'S OF RIO RANCHO, LLC
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:
6
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:
1932653458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2003 SOUTHERN BLVD SE
Provider Second Line Business Mailing Address:
SUITE 133 & 134
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87124-3751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-221-5740
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2003 SOUTHERN BLVD SE
Provider Second Line Business Practice Location Address:
SUITE 133 & 134
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87124-3751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-221-5740
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GREENE
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
505-400-3739

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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