NPIMap

Organization Active NPI

Pueblo of Isleta

Doing business as Pueblo of Isleta Dental Clinic

  • Public Health Dentistry
  • Isleta, NM
National Provider Identifier
1225158348
Registry record updated Aug 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health DentistryTaxonomy code 1223D0001X
License
501C Issued in NM
Legal business name
PUEBLO OF ISLETA
Doing business as
Pueblo of Isleta Dental Clinic
Practice address
01 Sagebrush Rd
Isleta, NM 87022-0000
Phone
(505) 869-4863
NPI assigned
Mar 30, 2007
Last updated
Aug 19, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2026

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

Authorized official

Name
Kimberly Pohl
Title
Ceo
Phone
(505) 869-3200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223D0001X 501C NM Primary

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 names 1

  • Pueblo of Isleta Dental Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Pueblo of Isleta Behavioral Health9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787097600000",
    "number": "1225158348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "01 SAGEBRUSH RD",
            "city": "ISLETA",
            "state": "NM",
            "postal_code": "870220000",
            "telephone_number": "505-869-4863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "01 SAGEBRUSH RD",
            "city": "ISLETA",
            "state": "NM",
            "postal_code": "870220000",
            "telephone_number": "505-869-4863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO OF ISLETA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2026-08-19",
        "certification_date": "2026-08-19",
        "status": "A",
        "authorized_official_last_name": "POHL",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "505-869-3200"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": "NM",
            "license": "501C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pueblo of Isleta Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Isleta, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.