| Bretmgreenddspc | |
|
8501 Candelaria Rd Ne Suite A2 Albuquerque NM 87112-1034 | |
| (505) 299-9606 | |
| Not Available |
| Full Name | Bretmgreenddspc |
|---|---|
| Speciality | Dentist |
| Location | 8501 Candelaria Rd Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Bret Michael Green (DR.) |
| Authorized Official Contact | 5052999606 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bretmgreenddspc 8501 Candelaria Rd Ne Suite A2 Albuquerque NM 87112-1034 Ph: (505) 299-9606 | Bretmgreenddspc 8501 Candelaria Rd Ne Suite A2 Albuquerque NM 87112-1034 Ph: (505) 299-9606 |
| NPI Number | 1770732208 |
|---|---|
| Provider Enumeration Date | 09/09/2008 |
| Last Update Date | 09/09/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770732208 | NPI | - | NPPES |
| 9177740 | Medicaid | NM | |
| 92935001 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DD2141 (New Mexico) | Primary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | DD2322 (New Mexico) | Secondary |
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