Healthcare Provider Details

I. General information

NPI: 1821583469
Provider Name (Legal Business Name): SANTA FE ORAL AND FACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 HOSPITAL DR
SANTA FE NM
87505-4763
US

IV. Provider business mailing address

1700 HOSPITAL DR
SANTA FE NM
87505-4763
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-2121
  • Fax:
Mailing address:
  • Phone: 505-988-2121
  • 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: BRETT SCHOW
Title or Position: OWNER
Credential:
Phone: 505-988-2121