Provider Demographics
NPI:1992035224
Name:PERFECT TEETH / VENADA PLAZA P.C.
Entity type:Organization
Organization Name:PERFECT TEETH / VENADA PLAZA P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCM, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-930-7707
Mailing Address - Street 1:510 NM 528
Mailing Address - Street 2:SUITE I
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004
Mailing Address - Country:US
Mailing Address - Phone:505-867-0665
Mailing Address - Fax:
Practice Address - Street 1:510 NM 528
Practice Address - Street 2:SUITE I
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004
Practice Address - Country:US
Practice Address - Phone:505-867-0665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM13981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty