NPIMap

Organization Active NPI

New Mexico Professional Dental Associates, Inc

Doing business as Alegre Dental @ Petroglyphs

  • General Practice Dentistry
  • Albuquerque, NM
National Provider Identifier
1366837643
Registry record updated Apr 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
NEW MEXICO PROFESSIONAL DENTAL ASSOCIATES, INC
Doing business as
Alegre Dental @ Petroglyphs
Practice address
2116 Vista Oeste NW Ste 202
Albuquerque, NM 87120-4341
Phone
(505) 836-1076
Fax
(505) 836-9809
NPI assigned
Apr 2, 2015
Last updated
Apr 2, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
NEW MEXICO PROFESSIONAL DENTAL ASSOCIATES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 2, 2015

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

2116 Vista Oeste NW Ste 202
Albuquerque, NM 87120-4341

Mailing address

2116 Vista Oeste NW Ste 202
Albuquerque, NM 87120-4341
Phone (505) 836-1076

Other names 1

  • Alegre Dental @ Petroglyphs 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.

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1427932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427932800000",
    "number": "1366837643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2116 VISTA OESTE NW STE 202",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871204341",
            "telephone_number": "505-836-1076",
            "fax_number": "505-836-9809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2116 VISTA OESTE NW STE 202",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871204341",
            "telephone_number": "505-836-1076",
            "fax_number": "505-836-9809"
        }
    ],
    "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": "2015-04-02",
        "last_updated": "2015-04-02",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CRED SUPERVISOR",
        "authorized_official_telephone_number": "217-540-5170"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alegre Dental @ Petroglyphs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2015; 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.