Provider Demographics
NPI:1487253522
Name:MARTY ARMIJO DDS PC
Entity type:Organization
Organization Name:MARTY ARMIJO DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMIJO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-897-7740
Mailing Address - Street 1:6100 COORS BLVD NW STE K6
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2776
Mailing Address - Country:US
Mailing Address - Phone:505-897-7740
Mailing Address - Fax:
Practice Address - Street 1:6100 COORS BLVD NW STE K6
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2776
Practice Address - Country:US
Practice Address - Phone:505-897-7740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARTY ARMIJO DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies