| Pearly Whites Dental Office, Inc. | |
|
4041 Barbara Loop Se Suite A Rio Rancho NM 87124-1065 | |
| (505) 891-1500 | |
| (505) 891-8400 |
| Full Name | Pearly Whites Dental Office, Inc. |
|---|---|
| Speciality | Dentist |
| Location | 4041 Barbara Loop Se, Rio Rancho, New Mexico |
| Authorized Official Name and Position | Shirley Ann Profazi (OWNER) |
| Authorized Official Contact | 5058911500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pearly Whites Dental Office, Inc. Po Box 15256 Rio Rancho NM 87174-0256 Ph: (505) 891-1500 | Pearly Whites Dental Office, Inc. 4041 Barbara Loop Se Suite A Rio Rancho NM 87124-1065 Ph: (505) 891-1500 |
| NPI Number | 1811009855 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811009855 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DD1948 (New Mexico) | Primary |
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