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General NPI Number Information
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NPI Number | 1629615851
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Entity Type | Organization
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Legal Business Name | SOUTHWEST ORAL AND MAXILLOFACIAL SURGEONS LLC
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Dates
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Enumeration Date | 12/06/2019
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Last Update Date | 12/06/2019
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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 | WAI PONG NG
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Credential | DMD
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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 | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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