NPIMap

Organization Active NPI

Pearly Whites Dental Hygiene, Inc.

  • Dental Hygienist
  • Rio Rancho, NM
National Provider Identifier
1740392778
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental HygienistTaxonomy code 124Q00000X
License
DH1218 Issued in NM
Legal business name
PEARLY WHITES DENTAL HYGIENE, INC.
Practice address
4041 Barbara Loop SE Ste a
Rio Rancho, NM 87124-1065
Phone
(505) 891-1500
Fax
(505) 891-8400
NPI assigned
Aug 31, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Shirley Ann Profazi, RDH
Title
Owner Dental Hygienist
Phone
(505) 891-1500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental HygienistGroup: 193400000X SINGLE SPECIALTY GROUP 124Q00000X DH1218 NM Primary

Addresses

Primary practice location

4041 Barbara Loop SE Ste a
Rio Rancho, NM 87124-1065

Mailing address

4041 Barbara Loop SE Ste a
Rio Rancho, NM 87124-1065
Phone (505) 891-1500

National Provider Directory

National Provider Directory
Tax ID family
Pearly Whites Dental Hygiene Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

4041 Barbara Loop SE
Ste A
Rio Rancho, NM 87124
Phone (505) 891-1500

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740392778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4041 BARBARA LOOP SE STE A",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241065",
            "telephone_number": "505-891-1500",
            "fax_number": "505-891-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4041 BARBARA LOOP SE STE A",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241065",
            "telephone_number": "505-891-1500",
            "fax_number": "505-891-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEARLY WHITES DENTAL HYGIENE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PROFAZI",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER DENTAL HYGIENIST",
        "authorized_official_telephone_number": "505-891-1500",
        "authorized_official_credential": "RDH"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dental Hygienist",
            "state": "NM",
            "license": "DH1218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 22, 2020; 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.