Provider Demographics
NPI:1871681700
Name:ALBUQUERQUE IMPLANT & PERIODONTAL CONSULTANTS. LLC
Entity type:Organization
Organization Name:ALBUQUERQUE IMPLANT & PERIODONTAL CONSULTANTS. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:505-291-9000
Mailing Address - Street 1:10425 MONTGOMERY PKWY NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3864
Mailing Address - Country:US
Mailing Address - Phone:505-291-9000
Mailing Address - Fax:505-294-3998
Practice Address - Street 1:10425 MONTGOMERY PKWY NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3864
Practice Address - Country:US
Practice Address - Phone:505-291-9000
Practice Address - Fax:505-294-3998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD27291223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty