Orthodental PC

Primary specialty

DentistTaxonomy code 122300000X

License

DD3399 Issued in NM

Legal business name

ORTHODENTAL PC

Practice address

1748 W Maloney Ave
Gallup, NM 87301-3333

Phone

(505) 863-8100

Fax

(505) 863-8064

NPI assigned

Mar 12, 2013

Organization subpart

No

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

Authorized official

Name

Joseph A Wilson, DMD, MSD

Title

Owner

Phone

(505) 325-8858

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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

• Celes Barbone, RDH

  • Dental Hygienist
  • Gallup, NM
  • NPI 1417699612
  NPD (past)

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

{
    "created_epoch": "1363046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363046400000",
    "number": "1750622072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1748 W MALONEY AVE",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873013333",
            "telephone_number": "505-863-8100",
            "fax_number": "505-863-8064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1748 W MALONEY AVE",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873013333",
            "telephone_number": "505-863-8100",
            "fax_number": "505-863-8064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHODENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-12",
        "last_updated": "2013-03-12",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-325-8858",
        "authorized_official_credential": "DMD, MSD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD3399",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NM",
            "license": "DD3399",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• One Care Pharmacy LLC (One Care Pharmacy)
• Kingsley Ikenna Onuoha, MD
• Rolly Jun Villanueva Ordeniza, RN
• Sarah Abygail Orillie, RN
• Jerry James Orr, CCSS
• Wanda Luz Ortiz Sanchez, RN
• Margarita Ortiz, FNP-C
• Vernon Anthony Osborn, PMHNP
• Bertha Osburn, RN
• Maria O Osegi, RN

• Dentist in Gallup, NM
• Providers in Gallup, NM by specialty
• Dentist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 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.