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NPI Code Detail

MEDICARE: WEST MESA ORAL AND MAXILLOFACIAL SURGERY PC

MEDICARE: WEST MESA ORAL AND MAXILLOFACIAL SURGERY PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223S0112XOral and Maxillofacial Surgery (Dentist)DD1819NM

General Provider Information

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

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Directions to “WEST MESA ORAL AND MAXILLOFACIAL SURGERY PC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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