1588085195 NPI number — UTOPIA DENTAL CARE

Table of content: (NPI 1588085195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588085195 NPI number — UTOPIA DENTAL CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UTOPIA DENTAL CARE
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:
1588085195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 RIO GRANDE BLVD NW
Provider Second Line Business Mailing Address:
154G
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87104-2057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-363-3435
Provider Business Mailing Address Fax Number:
505-899-6192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 RIO GRANDE BLVD NW
Provider Second Line Business Practice Location Address:
154G
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87104-2057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-363-3435
Provider Business Practice Location Address Fax Number:
505-899-6192
Provider Enumeration Date:
12/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BARKLEY
Authorized Official First Name:
DARLY
Authorized Official Middle Name:
GERMAIN
Authorized Official Title or Position:
DENTAL HYGIENIST
Authorized Official Telephone Number:
505-363-3435

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com