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Oral and Maxillofacial Surgery

Albuquerque, New Mexico

Provider NPI: 1174512297

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
Tel: 505-292-3400  Fax: 505-292-7124

Business Mailing Address:
Tel: 505-292-3400  Fax: 505-292-7124

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y1223S0112XDental Providers
Oral and Maxillofacial Surgery

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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