NPIMap

Organization Active NPI

Cottonwood Mall Dental Practice, LLC

  • Dental Clinic/Center
  • Albuquerque, NM
National Provider Identifier
1043487119
Registry record updated Apr 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
COTTONWOOD MALL DENTAL PRACTICE, LLC
Practice address
10000 Coors Byp NW
# G-218
Albuquerque, NM 87114-4040
Phone
(505) 242-4867
Fax
(505) 890-2883
NPI assigned
May 8, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2019

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

Authorized official

Name
Dr. William A. Sapp, DDSNPI 1952381774
Title
President
Phone
(505) 242-4867

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
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

10000 Coors Byp NW
# G-218
Albuquerque, NM 87114-4040

Mailing address

10000 Coors Byp NW
# G-218
Albuquerque, NM 87114-4040
Phone (505) 242-4867

Other identifiers 1

IdentifierTypeStateIssuer
1440525OtherNMUNITED CONCORDIA

National Provider Directory

National Provider Directory

Locations

10320 Cottonwood Park NW
Albuquerque, NM 87114
Phone (505) 250-5204

10000 Coors Bypass NW
Ste G218
Albuquerque, NM 87114
Phone (505) 242-4867

Practitioners & affiliated clinicians

Practitioners 7

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": "1210204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556582400000",
    "number": "1043487119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10000 COORS BYP NW",
            "address_2": "# G-218",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871144040",
            "telephone_number": "505-242-4867",
            "fax_number": "505-890-2883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10000 COORS BYP NW",
            "address_2": "# G-218",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871144040",
            "telephone_number": "505-242-4867",
            "fax_number": "505-890-2883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COTTONWOOD MALL DENTAL PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-08",
        "last_updated": "2019-04-30",
        "status": "A",
        "authorized_official_last_name": "SAPP",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "505-242-4867",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1440525",
            "state": "NM"
        }
    ],
    "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 Apr 30, 2019; 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.