Open Wide Dentistry LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

OPEN WIDE DENTISTRY LLC

Practice address

1100 Lead Ave SE
Albuquerque, NM 87106

Phone

(505) 292-8533

Fax

(505) 292-2712

NPI assigned

Sep 25, 2008

Last updated

Sep 25, 2008By 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. Sandra Lee Keanna

Title

Owner

Phone

(505) 292-8533

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1222300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222300800000",
    "number": "1255581393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 LEAD AVE SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871065215",
            "telephone_number": "505-292-8533",
            "fax_number": "505-292-2712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 LEAD AVE SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87106",
            "telephone_number": "505-292-8533",
            "fax_number": "505-292-2712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN WIDE DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-25",
        "last_updated": "2008-09-25",
        "status": "A",
        "authorized_official_last_name": "KEANNA",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-292-8533",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Dental Clinic/Center in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2008; 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.