Provider Demographics
NPI:1700498037
Name:ABQ GENTLE DENTISTRY LLC
Entity type:Organization
Organization Name:ABQ GENTLE DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFFERTY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:505-292-8588
Mailing Address - Street 1:4550 EUBANK BLVD NE STE 101
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2565
Mailing Address - Country:US
Mailing Address - Phone:505-292-8588
Mailing Address - Fax:505-292-3100
Practice Address - Street 1:4550 EUBANK BLVD NE STE 101
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2565
Practice Address - Country:US
Practice Address - Phone:505-292-8588
Practice Address - Fax:505-292-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental