NPIMap

Organization Active NPI

New Mexico Professional Dental Associates, Inc

  • General Practice Dentistry
  • Rio Rancho, NM
National Provider Identifier
1255764650
Registry record updated Aug 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
NEW MEXICO PROFESSIONAL DENTAL ASSOCIATES, INC
Practice address
4120 Barbara Loop SE
Rio Rancho, NM 87124-1000
Phone
(505) 892-8088
NPI assigned
Aug 21, 2013
Organization subpart
Yes
Parent organization
NEW MEXICO PROFESSIONAL DENTAL ASSOCIATES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 21, 2013

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

Authorized official

Name
Kim Wilson
Title
Credentialing Supervisor
Phone
(217) 540-5170

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

4120 Barbara Loop SE
Rio Rancho, NM 87124-1000

Mailing address

4120 Barbara Loop SE
Rio Rancho, NM 87124-1000
Phone (505) 892-8088

Other names 1

  • Rio Rancho Dental Arts Doing business as

National Provider Directory

National Provider Directory
Tax ID family
New Mexico Professional Dental7 organizations share this tax ID, including this one
Part of
New Mexico Professional Dental

Other organizations with this tax ID 6

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

Locations

4120 Barbara Loop SE
Rio Rancho, NM 87124
Phone (505) 498-3235

NPI Registry JSON

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

{
    "created_epoch": "1377043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377043200000",
    "number": "1255764650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4120 BARBARA LOOP SE",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241000",
            "telephone_number": "505-892-8088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4120 BARBARA LOOP SE",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241000",
            "telephone_number": "505-892-8088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW MEXICO PROFESSIONAL DENTAL ASSOCIATES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NEW MEXICO PROFESSIONAL DENTAL ASSOCIATES, INC",
        "enumeration_date": "2013-08-21",
        "last_updated": "2013-08-21",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "217-540-5170"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rio Rancho Dental Arts",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rio Rancho, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2013; 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.