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General NPI Number Information
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NPI Number | 1598929242
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Entity Type | Organization
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Legal Business Name | WEST MESA ORAL AND MAXILLOFACIAL SURGERY PC
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Dates
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Enumeration Date | 07/11/2008
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 4801 MCMAHON BLVD NW STE 230
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5478
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Country | US
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Telephone | 505-792-4788
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Fax | 505-792-2533
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Provider Business Mailing Address
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Address Line | 4801 MCMAHON BLVD NW STE 230
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5478
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Country | US
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Telephone | 505-792-4788
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Fax |
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Authorized Official
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Title or Position | ACCOUNTS RECEIVABLE
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Name | MRS. SHANNON ROYBAL
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Credential |
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Telephone | 505-792-4788
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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 | DD1819
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License Number State | NM
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