NPIMap

Organization Active NPI

Albuquerque West Smiles Youth Dentistry, PC

  • General Practice Dentistry
  • Albuquerque, NM
National Provider Identifier
1730137217
Registry record updated Sep 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ALBUQUERQUE WEST SMILES YOUTH DENTISTRY, PC
Practice address
111 Coors Blvd NW
E-6
Albuquerque, NM 87121-2006
Phone
(505) 352-3808
Fax
(505) 352-3811
NPI assigned
May 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2014

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

Authorized official

Name
Mrs. Kim Freeman
Title
Regional Manager
Phone
(505) 377-9911

Specialties & licenses 1

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

Addresses

Primary practice location

111 Coors Blvd NW
E-6
Albuquerque, NM 87121-2006

Mailing address

111 Coors Blvd NW Ste E6
Albuquerque, NM 87121-2009
Phone (505) 352-3808

Other identifiers 1

IdentifierTypeStateIssuer
77532MedicaidNM

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412035200000",
    "number": "1730137217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 COORS BLVD NW STE E6",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871212009",
            "telephone_number": "505-352-3808",
            "fax_number": "505-352-3811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 COORS BLVD NW",
            "address_2": "E-6",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871212006",
            "telephone_number": "505-352-3808",
            "fax_number": "505-352-3811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBUQUERQUE WEST SMILES YOUTH DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2014-09-30",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "REGIONAL MANAGER",
        "authorized_official_telephone_number": "505-377-9911",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77532",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Sep 30, 2014; 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.