Albuquerque East Smiles Youth Dentistry, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ALBUQUERQUE EAST SMILES YOUTH DENTISTRY, PC

Practice address

201 San Pedro Dr SE
Suite B-2
Albuquerque, NM 87108-3009

Phone

(505) 232-5437

Fax

(505) 254-7649

NPI assigned

May 7, 2006

Last updated

Sep 30, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Kim Freeman

Title

Regional Manager

Phone

(505) 377-9911

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1146960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412035200000",
    "number": "1144279381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 SAN PEDRO DR SE STE B2",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871083009",
            "telephone_number": "505-232-5437",
            "fax_number": "505-254-7649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 SAN PEDRO DR SE",
            "address_2": "SUITE B-2",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871083009",
            "telephone_number": "505-232-5437",
            "fax_number": "505-254-7649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBUQUERQUE EAST SMILES YOUTH DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-07",
        "last_updated": "2014-09-30",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "REGIONAL MANAGER",
        "authorized_official_telephone_number": "505-377-9911",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "93175027",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Albuquerque Emergency Group LLC
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• Albuquerque Emotional Wellness
• Albuquerque ER LLC (Albuquerque ER & Medical Hospital)

• General Practice Dentistry in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2014; 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.