Healthcare Provider Details

I. General information

NPI: 1730172735
Provider Name (Legal Business Name): MUGLIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W ALAMEDA ST
ROSWELL NM
88203-4403
US

IV. Provider business mailing address

711 W ALAMEDA ST
ROSWELL NM
88203-4403
US

V. Phone/Fax

Practice location:
  • Phone: 505-623-4448
  • Fax: 505-623-9571
Mailing address:
  • Phone: 505-623-4448
  • Fax: 505-623-9571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number97218
License Number StateNM

VIII. Authorized Official

Name: DR. MARGARET V DENTON
Title or Position: DIRECT OWNER
Credential: MD
Phone: 505-623-4448