Basic Information
Provider Information
NPI: 1992283576
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARCE
FirstName: JUSEMMY
MiddleName: HAYDEE
NamePrefix:  
NameSuffix:  
Credential: DMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6304 BELCHER AVE NE
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871094112
CountryCode: US
TelephoneNumber: 7862581903
FaxNumber:  
Practice Location
Address1: 6230 PASEO DEL NORTE NE STE B
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871132568
CountryCode: US
TelephoneNumber: 5052443000
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/05/2018
LastUpdateDate: 08/05/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000XDD4963NMY Dental ProvidersDentist 

No ID Information.


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