NPIMap

Organization Active NPI

Pearly Whites Dental Office, Inc.

  • Dentist
  • Rio Rancho, NM
National Provider Identifier
1811009855
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DD1948 Issued in NM
Legal business name
PEARLY WHITES DENTAL OFFICE, INC.
Practice address
4041 Barbara Loop SE
Suite 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
Phone
(505) 891-1500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DD1948 NM Primary

Addresses

Primary practice location

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

Mailing address

PO Box 15256
Rio Rancho, NM 87174-0256
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.

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": "1811009855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15256",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871740256",
            "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",
            "address_2": "SUITE 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 OFFICE, 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",
        "authorized_official_telephone_number": "505-891-1500",
        "authorized_official_credential": "RDH"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD1948",
            "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.