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General NPI Number Information
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NPI Number | 1457527368
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Entity Type | Organization
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Legal Business Name | SOUTHWEST ORAL & MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 5900 CUBERO DR NE STE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3879
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Country | US
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Telephone | 505-797-3530
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Fax | 505-797-2155
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Provider Business Mailing Address
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Address Line | 5900 CUBERO DR NE STE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3879
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Country | US
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Telephone | 505-797-3530
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Fax | 505-797-2155
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Authorized Official
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Title or Position | OWNER
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Name | DR. JERRY L JONES
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Credential | M.D.,D.D.S.
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Telephone | 505-797-3530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DD1094
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License Number State | NM
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