Provider Demographics
NPI:1215313192
Name:ABQ DENTAL HYGIENE SERVICES
Entity type:Organization
Organization Name:ABQ DENTAL HYGIENE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:LYUDMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:505-507-2227
Mailing Address - Street 1:717 ENCINO PL NE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2611
Mailing Address - Country:US
Mailing Address - Phone:505-507-2227
Mailing Address - Fax:
Practice Address - Street 1:920 SEATTLE SLEW AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-2326
Practice Address - Country:US
Practice Address - Phone:505-507-2227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH 1495124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty