505 DENTAL LLC (NPI# 1710404504) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710404504 |
| Entity Type | Organization |
| Organization Name | 505 DENTAL LLC |
| Other Organization Name | AMERICAN INSTITUTE OF DENTAL ASSISTING |
| Practice Address |
2901 Juan Tabo Blvd Ne Ste 10 Albuquerque NM 87112-1885 |
| Practice Telephone | (505) 395-6240 |
| Practice Fax Number | 5052145132 |
| Mailing Telephone | 5053956240 |
| Mailing Fax Number | 5052145132 |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2017-08-23 |
| Authorized Official Name | DR. JONAH L FOUTZ (OWNER/CEO) |
| Authorized Official Telephone | 5053956240 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
DDS662 | NM | Dental Providers |
| Other Name | Type Code |
|---|---|
| American Institute of Dental Assisting | Doing Business As Name - Organization |
| Street Address |
2901 JUAN TABO BLVD NE STE 10 |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87112-1885 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497255400 | New Mexico Migraine Clinic LLC | Clinic/Center | 2901 Juan Tabo Blvd Ne Ste 10, Albuquerque, NM 87112-1885 | 2018-02-15 |
| 1215446430 | Aida New Mexico Clinics | Dentist | 2901 Juan Tabo Blvd Ne Ste 10, Albuquerque, NM 87112-1885 | 2017-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356999411 | Lynn Eileen Riley | Counselor | 10205 Stovall Pl Ne, Albuquerque, NM 87112 | 2019-08-30 |
| 1548818222 | Cindy D Montoya | Technician | 11405 Snow Heights Blvd Ne, Albuquerque, NM 87112 | 2019-08-27 |
| 1194387449 | Karen Sue Stockham | Counselor | 9024 Aspen Ave Ne, Albuquerque, NM 87112 | 2019-07-07 |
| 1316416837 | New Beginning Counseling Services Inc | Counselor | 2617 Juan Tabo Blvd Ne Unit A/d, Albuquerque, NM 87112 | 2018-11-14 |
| 1306365929 | Calyx Institute LLC | Social Worker | 10701 Lomas Blvd Ne, Ste. 101, Albuquerque, NM 87112 | 2017-09-14 |
| 1811411135 | Annette Romero | Case Manager/Care Coordinator | 9741 Candelaria, Albuquerque, NM 87112 | 2017-07-28 |
| 1851814784 | Ally Renee Funkhouser Dye | Pediatrics | 2130 Eubank Blvd Ne, Albuquerque, NM 87112 | 2017-07-23 |
| 1508303140 | Makena Bailey Nash | Behavior Technician | 12801 Indian School Ne Apt 508, Albuquerque, NM 87112 | 2017-01-20 |
| 1477978906 | Albert R Toya | Massage Therapist | 2601 Wyoming Blvd N.e. Room 115-c, Albuquerque, NM 87112 | 2014-02-20 |
| 1184918104 | Jennifer E Chavez | Counselor | 1505 Marron Circle Ne, Albuquerque, NM 87112 | 2011-06-07 |
| Find all providers in zip 87112 | ||||
| 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 |
|---|---|---|---|---|
| 1841803830 | Tri Dental, LLC | Dentist | 3715 Las Estancias Ct Sw Ste 101, Albuquerque, NM 87121-5506 | 2020-08-28 |
| 1609485077 | Joseph Potter | Dentist | 3510 Coors Blvd Sw, Albuquerque, NM 87121-5328 | 2020-07-30 |
| 1861024861 | Brian K Dennis Dds PC | Dentist | 8400 Osuna Rd Ne Ste 6a, Albuquerque, NM 87111-2073 | 2020-02-07 |
| 1134769235 | Abq Dentists PC | Dentist | 3900 Eubank Blvd Ne Ste 14, Albuquerque, NM 87111-3427 | 2020-01-07 |
| 1477197804 | Juan Tabo Dentistry LLC | Dentist | 1924 Juan Tabo Blvd Ne Ste C, Albuquerque, NM 87112-3358 | 2019-10-29 |
| 1013550094 | Bosque Smiles Dentistry, LLC | Dentist | 5600 Coors Blvd Nw Ste G4, Albuquerque, NM 87120-1877 | 2019-10-23 |
| 1134686298 | Brandon James Clayton | Dentist | 2003 Southern Blvd Se # 133-134, Albuquerque, NM 87124-3751 | 2019-02-25 |
| 1881158822 | Advantage Dental Care | Dentist | 9212 Montgomery Blvd Ne, Albuquerque, NM 87111-2408 | 2019-01-23 |
| 1124599253 | Kirtland Family Dentistry LLC | Dentist | 8521 Central Ave Ne Ste 101, Albuquerque, NM 87108-2501 | 2018-12-16 |
| 1962998443 | Salia Khayoumi | Dentist | 333 San Mateo Blvd Se, Albuquerque, NM 87108-2919 | 2018-07-08 |
| Find all providers in ALBUQUERQUE | ||||
| City | ALBUQUERQUE |
| Zip Code | 87112 |
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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.