Gretchen Marie Kelley, DDS
Individual provider Active NPI General Practice Dentistry · Albuquerque, NM
NPI 1053676734 · NPPES record last updated Jul 10, 2012
Key facts
- NPI
- 1053676734
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DD3709 (NM)
- Practice address
- 9501 Paseo del Norte NE Ste a
Albuquerque, NM 87122-2999 - Phone
- (505) 369-1881
- Fax
- (505) 369-1882
- NPI assigned
- Jul 10, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD3709 | NM | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Desert Ridge Dental | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DD3709 | NM | Yes |
Addresses
Primary practice location
9501 Paseo del Norte NE Ste a
Albuquerque, NM 87122-2999
Mailing address
9501 Paseo del Norte NE Ste a
Albuquerque, NM 87122-2999
Phone (505) 369-1881
Other providers in Albuquerque, NM
- Karolayn Keller
- Meredith Keller
- Rebecca Lynn Keller
- Stephen C Keller
- Evoanna Kileen Kelley Correa
- Isabella Kelley
- Jonathan Harper Kelley
- Matthew Brian Kelley
- Naomi Kelley
- Ray Kelley
All providers in Albuquerque, NM · General Practice Dentistry in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.