NPIMap

Organization Active NPI

Great White Dentistry

Doing business as Isham Dental

  • General Practice Dentistry
  • Albuquerque, NM
National Provider Identifier
1639663792
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DD4733 Issued in NM
Legal business name
GREAT WHITE DENTISTRY
Doing business as
Isham Dental
Practice address
5555 Montgomery Blvd NE Ste 17
Albuquerque, NM 87109-1445
Phone
(505) 881-0422
NPI assigned
Jun 21, 2018
Last updated
Jun 21, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2018

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

Authorized official

Name
Dr. Michael Scott Isham, DMDNPI 1548782352
Title
Owner/Dentist
Phone
(505) 881-0422

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DD4733 NM Primary

Addresses

Primary practice location

5555 Montgomery Blvd NE Ste 17
Albuquerque, NM 87109-1445

Mailing address

5555 Montgomery Blvd NE Ste 17
Albuquerque, NM 87109-1445
Phone (505) 881-0422

Other identifiers 1

IdentifierTypeStateIssuer
48108588MedicaidNM

Other names 1

  • Isham Dental Doing business as

National Provider Directory

National Provider Directory

Locations

5555 Montgomery Blvd NE
Ste 17
Albuquerque, NM 87109
Phone (505) 881-0422

Practitioners & affiliated clinicians

Practitioners 1

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": "1529539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1639663792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 MONTGOMERY BLVD NE STE 17",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871091445",
            "telephone_number": "505-881-0422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 MONTGOMERY BLVD NE STE 17",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871091445",
            "telephone_number": "505-881-0422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT WHITE DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-21",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "ISHAM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "505-881-0422",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD4733",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "48108588",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Isham Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Isham Dental",
            "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 Jun 21, 2018; 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.