Provider Demographics
NPI:1851182612
Name:MOUNTAIN VIEW PEDIATRIC DENTISTRY LLC
Entity type:Organization
Organization Name:MOUNTAIN VIEW PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHULETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-377-9909
Mailing Address - Street 1:1574 LAKELAND GRV APT 103
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-6264
Mailing Address - Country:US
Mailing Address - Phone:505-377-9909
Mailing Address - Fax:
Practice Address - Street 1:1904 WELLSPRING AVE SE STE 105
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4888
Practice Address - Country:US
Practice Address - Phone:505-415-0462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty