Pueblo of Isleta
Organization Active NPI Public Health Dentistry · Isleta, NM
NPI 1225158348 · NPPES record last updated Aug 19, 2026
Key facts
- NPI
- 1225158348
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Public Health Dentistry 1223D0001X
- License
- 501C (NM)
- Legal business name
- PUEBLO OF ISLETA
- Practice address
- 01 Sagebrush Rd
Isleta, NM 87022-0000 - Phone
- (505) 869-4863
- NPI assigned
- Mar 30, 2007
- Organization subpart
- No
Authorized official
- Name
- Kimberly Pohl
- Title
- Ceo
- Phone
- (505) 869-3200
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 8
Practitioners 22
-
Laura Ahrens, LMSW
-
Lisa K Cherino, LMSW,LADAC
-
Jessica Chynoweth, M.D
-
Sarah Michelle Hayes, NURSE PRACTITIONER
-
Ryan Holiday, OD
-
Ray Kelley, MD
-
Anna Kistin, MD
-
Daniel Langsam, MD
-
Theresa Ortiz, LMSW
-
Gabriel I Rael, LMHC
-
Pearlyn Gail Tomosie, M.D.
-
Joel A. Di Santi, DPM
-
Paige Elizabeth Gaut, DPT
-
Mark William Hedrick, AUD, CCC-A
-
Merel Hancock, RDH
-
Lisen A. Krueger, RDH
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040616000379 | NM | Part B Supplier - Clinic/Group Practice | 9739080631 |
Receives reassigned benefits from 25 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Albuquerque, NM |
National Provider Directory
- Tax ID family
- Pueblo of Isleta Behavioral Health
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health Dentistry |
1223D0001X | 501C | NM | Yes |
Addresses
Primary practice location
01 Sagebrush Rd
Isleta, NM 87022-0000
Mailing address
01 Sagebrush Rd
Isleta, NM 87022-0000
Phone (505) 869-4863
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 55528309 | Medicaid | NM |
Other names
- Pueblo of Isleta Dental Clinic
Other providers in Isleta, NM
- Erin R Nelson
- Riley Nelson
- Pueblo of Isleta
- Pueblo of Isleta
- Pueblo of Isleta
- Pueblo of Isleta
- Pueblo of Isleta
- Pueblo of Isleta Assisted Living Facility
- Pueblo of Isleta Behavioral Health
- Gabriel I Rael
All providers in Isleta, NM · Public Health 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 Aug 19, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.