National Provider Identifier Database

OPEN WIDE DENTISTRY LLC
Dental


Contact Information

OPEN WIDE DENTISTRY LLC
1100 LEAD AVE SE
ALBUQUERQUE, NM87106
Phone: 505-292-8533
Fax: 505-292-2712
Website:
Specialty Taxonomy Code
* Dental 261QD0000X

* Indicates primary specialty

NPI Profile & details for OPEN WIDE DENTISTRY LLC

NPI Number 1255581393
Legal business name
LBN
OPEN WIDE DENTISTRY LLC
Authorized official SANDRA KEANNA - (OWNER)
Entity Organization
Organization subpart No
Enumeration date 09/25/2008
Last updated 09/25/2008 - About 18 years ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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