OPEN WIDE DENTISTRY LLC; NPI #1255581393

Contact Information

OPEN WIDE DENTISTRY LLC

1100 LEAD AVE SE
ALBUQUERQUE, NM 87106

Phone: 505-292-8533
Fax: 505-292-2712
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Dental	261QD0000X

Indicates primary specialty

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NPI Profile & details for OPEN WIDE DENTISTRY LLC

NPI #	`1255581393`
LBN Legal business name	OPEN WIDE DENTISTRY LLC
Authorized official	SANDRA KEANNA - (OWNER)
Entity	Organization
Organization subpart ¹	No
Enumeration date	09/25/2008
Last updated	09/25/2008 - About 18 years ago
Identifiers	n/a

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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