NPIMap

Organization Active NPI

CRDS

  • Dentist
  • Albuquerque, NM
National Provider Identifier
1013390087
Registry record updated Jul 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DD4332 Issued in NM
Legal business name
CRDS
Practice address
2800 Coors Blvd NW Ste a
Albuquerque, NM 87120-1204
Phone
(505) 350-1166
Fax
(505) 352-2805
NPI assigned
Jul 8, 2015
Organization subpart
Yes
Parent organization
ALBUQUERQUE MODERN DENTISTRYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 8, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michael Ross Conner, DDSNPI 1225407604
Title
Dentist
Phone
(575) 642-4779

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X DD4332 NM Primary

Addresses

Primary practice location

2800 Coors Blvd NW Ste a
Albuquerque, NM 87120-1204

Mailing address

2800 Coors Blvd NW Ste a
Albuquerque, NM 87120-1204
Phone (505) 350-1166

National Provider Directory

National Provider Directory
Tax ID family
Amanda Girardi5 organizations share this tax ID, including this one
Part of
Albuquerque Modern Dentistry LLC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436313600000",
    "number": "1013390087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 COORS BLVD NW STE A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871201204",
            "telephone_number": "505-350-1166",
            "fax_number": "505-352-2805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 COORS BLVD NW STE A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871201204",
            "telephone_number": "505-350-1166",
            "fax_number": "505-352-2805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRDS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALBUQUERQUE MODERN DENTISTRY",
        "enumeration_date": "2015-07-08",
        "last_updated": "2015-07-08",
        "status": "A",
        "authorized_official_last_name": "CONNER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ROSS",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "575-642-4779",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD4332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.