Basic Information
| Provider Information | |||||||||
| NPI: | 1366798936 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALLEROS | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | R.D.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1004 MESILLA ST NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871107220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052666508 | ||||||||
| FaxNumber: | 5052666449 | ||||||||
| Practice Location | |||||||||
| Address1: | MSC 09 5020 NOVITSKI HL | ||||||||
| Address2: | 1 UNIVERSITY OF NEW MEXICO | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052724513 | ||||||||
| FaxNumber: | 5052725584 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2012 | ||||||||
| LastUpdateDate: | 08/01/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | DH2552 | NM | Y | Dental Providers | Dental Hygienist |
No ID Information.