| Pueblo Of Isleta Dental Clinic | |
|
01 Sagebrush Rd Isleta NM 87022-0000 | |
| (505) 869-4863 | |
| Not Available |
| Full Name | Pueblo Of Isleta Dental Clinic |
|---|---|
| Speciality | Dentist - Dental Public Health |
| Location | 01 Sagebrush Rd, Isleta, New Mexico |
| Authorized Official Name and Position | Volelle K Zamora (CEO) |
| Authorized Official Contact | 5058694094 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pueblo Of Isleta Dental Clinic 01 Sagebrush Rd Isleta NM 87022-0000 Ph: (505) 869-4863 | Pueblo Of Isleta Dental Clinic 01 Sagebrush Rd Isleta NM 87022-0000 Ph: (505) 869-4863 |
| NPI Number | 1225158348 |
|---|---|
| Provider Enumeration Date | 03/30/2007 |
| Last Update Date | 05/17/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225158348 | NPI | - | NPPES |
| 55528309 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | 501C (New Mexico) | Primary |