NPIMap

Organization Active NPI

Albuquerque Modern Dentistry, LLC

  • General Practice Dentistry
  • Albuquerque, NM
National Provider Identifier
1487953790
Registry record updated Nov 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ALBUQUERQUE MODERN DENTISTRY, LLC
Practice address
2800- A Coors Blvd NW
Albuquerque, NM 87120-1204
Phone
(505) 352-1166
Fax
(505) 352-2805
NPI assigned
Mar 25, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2013

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

Authorized official

Name
Dr. Mario Herrejon-Ruiz, DMD
Title
Owner Doctor
Phone
(505) 352-1166

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

2800- A Coors Blvd NW
Albuquerque, NM 87120-1204

Mailing address

17000 Red Hill Ave
Irvine, CA 92614-5626
Phone (714) 845-8890

Other names 1

  • Albuquerque Modern Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

2800 Coors Blvd NW
Ste A
Albuquerque, NM 87120
Phone (505) 350-1166

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1301011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384732800000",
    "number": "1487953790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17000 RED HILL AVE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926145626",
            "telephone_number": "714-845-8890",
            "fax_number": "949-474-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800- A COORS BLVD NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871201204",
            "telephone_number": "505-352-1166",
            "fax_number": "505-352-2805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBUQUERQUE MODERN DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-25",
        "last_updated": "2013-11-18",
        "status": "A",
        "authorized_official_last_name": "HERREJON-RUIZ",
        "authorized_official_first_name": "MARIO",
        "authorized_official_title_or_position": "OWNER DOCTOR",
        "authorized_official_telephone_number": "505-352-1166",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Albuquerque Modern Dentistry",
            "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 Nov 18, 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.