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Organization
SAN JUAN ORAL & FACIAL SURGERY
Active
Organization
SAN JUAN ORAL & FACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEVERLY K BRADFORD DDS (OFFICE MANAGER)
(505) 333-8635
Entity
Organization
Contact information
Practice address
2990 E PINON FRONTAGE RD STE 102, FARMINGTON, NM 87402-5068
(505) 333-8635
(505) 258-4909
Mailing address
2990 E PINON FRONTAGE RD STE 102, FARMINGTON, NM 87402-5068
(505) 333-8635
(505) 258-4909
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
09/18/2014
Last updated
03/03/2021
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