FAMILIA DENTAL ESP LLC (NPI# 1356634703) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356634703 |
| Entity Type | Organization |
| Organization Name | FAMILIA DENTAL ESP LLC |
| Other Organization Name | FAMILIA DENTAL |
| Practice Address |
1508 N Riverside Dr Espanola NM 87532-2054 |
| Mailing Address |
2000 E Algonquin Rd Suite 109 Schaumburg IL 60173-4189 |
| Practice Telephone | 8889884066 |
| Practice Fax Number | 8474967603 |
| Mailing Telephone | 8889884066 |
| Mailing Fax Number | 8474967603 |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2011-05-18 |
| Authorized Official Name | DR. KOUSHAN H. AZAD (PRESIDENT) |
| Authorized Official Telephone | 8889884066 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Other Name | Type Code |
|---|---|
| FAMILIA DENTAL | Doing Business As Name - Organization |
| Street Address |
1508 N RIVERSIDE DR |
| City | ESPANOLA |
| State | NM |
| Zip Code | 87532-2054 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861005662 | Kevin Chun Hui Chang | Dentist | 1508 N Riverside Dr, Espanola, NM 87532-2064 | 2020-08-31 |
| 1275172181 | Brent Lee Jorgensen | Dentist | 1508 N Riverside Dr, Espanola, NM 87532-2064 | 2019-12-26 |
| 1235782566 | Muhammad Atif Khan | Dentist | 1508 N Riverside Dr, Espanola, NM 87532-2064 | 2019-07-16 |
| 1780100065 | Sun Young Park | Dentist | 1508 N Riverside Dr, Espanola, NM 87532-2064 | 2017-08-17 |
| 1811413594 | Chris Y. Kim | Dentist | 1508 N Riverside Dr, Espanola, NM 87532-2064 | 2017-08-15 |
| 1841715992 | Suho Bae | Dentist | 1508 N Riverside Dr, Espanola, NM 87532-2064 | 2017-08-10 |
| 1730632761 | Jaesung Seo | Dentist | 1508 N Riverside Dr, Espanola, NM 87532-2064 | 2016-07-26 |
| 1285912048 | Sara Hakimzadeh | Dentist | 1508 N Riverside Dr, Espanola, NM 87532-2054 | 2011-07-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720690423 | David A. Bustos | Non-emergency Medical Transport (VAN) | 1736 Calle Culebra, Espanola, NM 87532 | 2020-08-24 |
| 1407484942 | Rosita Lorreyna Sanchez | Behavior Technician | 3 Calle Baca, Espanola, NM 87532 | 2020-03-30 |
| 1437615564 | Troy Campbell | Counselor | 19525 Tomas Ln, Espanola, NM 87532 | 2019-02-13 |
| 1174099428 | Marisa Anaya | Registered Nurse | 420 N Coronado Ave, Espanola, NM 87532 | 2018-10-15 |
| 1780169938 | Celina Velasquez | Specialist/Technologist | 8 Camino Velasquez Ln., Espanola, NM 87532 | 2018-10-03 |
| 1356864656 | Jacqueline Andrea Zamora Alvarado | Behavior Technician | 3 Boneyard Rd, Espanola, NM 87532 | 2017-07-19 |
| 1619423902 | Mariah Maureen Martinez | Specialist/Technologist | 1421 Montana Vista St, Espanola, NM 87532 | 2016-08-28 |
| 1851847180 | Shannon Vigil | Perfusionist | 829 Calle Juan Jose Vigil, Espanola, NM 87532 | 2016-08-28 |
| 1144684234 | Tanya P. Reyes | Family Medicine | El Centro Family Health, 2010 Industrial Park Rd., Espanola, NM 87532 | 2016-04-05 |
| 1780058768 | Kale Lee Dennis | Massage Therapist | 2 Old Orchard Ln, Espanola, NM 87532 | 2015-11-13 |
| Find all providers in zip 87532 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356401194 | Valerie Nicole Lapolla | Dentist | Rr 5 Box 446, Santa Clara Health Center, Espanola, NM 87532-8908 | 2006-12-11 |
| 1922177385 | Michael S Redman | Dentist | 704 La Joya St, Espanola, NM 87532-2599 | 2006-11-07 |
| 1083725238 | Robert J Manzanares | Dentist | 232 Paseo De Onate, Espanola, NM 87532 | 2006-08-31 |
| 1104845486 | Michael Stephen Dondelinger | Dentist | 608 Lajoya St., Suite B, Espanola, NM 87532 | 2006-07-18 |
| 1558336883 | Robert W Daniels | Dentist | 111 N Railroad Ave, Espanola, NM 87532-2627 | 2006-02-21 |
| 1780100065 | Sun Young Park | Dentist | 1508 N Riverside Dr, Espanola, NM 87532-2064 | 2017-08-17 |
| 1811413594 | Chris Y. Kim | Dentist | 1508 N Riverside Dr, Espanola, NM 87532-2064 | 2017-08-15 |
| 1841715992 | Suho Bae | Dentist | 1508 N Riverside Dr, Espanola, NM 87532-2064 | 2017-08-10 |
| 1285912048 | Sara Hakimzadeh | Dentist | 1508 N Riverside Dr, Espanola, NM 87532-2054 | 2011-07-28 |
| 1760651277 | Michael S. Redman, D.m.d., P.C. | Dentist | 704 La Joya St, Espanola, NM 87532-2599 | 2008-02-28 |
| Find all providers in ESPANOLA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.