Healthcare Provider Details

I. General information

NPI: 1043967813
Provider Name (Legal Business Name): ALBUQUERQUE ORAL SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 MONTGOMERY BLVD NE STE A
ALBUQUERQUE NM
87109-1425
US

IV. Provider business mailing address

6800 MONTGOMERY BLVD NE STE A
ALBUQUERQUE NM
87109-1425
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-1130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. DAYNE JENSEN
Title or Position: OWNER
Credential: MD, DMD
Phone: 801-698-7121