# SOUTHERN BLVD DENTAL CORP, PA

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316963739
- **Authorized official:** DR. MARTIN G GOEBBEL DDS (PRESIDENT/OWNER)
- **Authorized official phone:** (505) 892-8600

## Contact information

- **Practice address:** 2716 SOUTHERN BLVD SE, RIO RANCHO, NM 87124-3741
- **Practice address phone:** (505) 892-8600
- **Practice address fax:** (505) 892-4215
- **Mailing address:** 2716 SOUTHERN BLVD SE, RIO RANCHO, NM 87124-3741
- **Mailing address phone:** (505) 892-8600
- **Mailing address fax:** (505) 892-4215

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DD1498 | NM | Yes |
| 1223G0001X | General Practice Dentistry | DD1523 | NM | — |

## Other

- **Enumeration date:** 07/15/2006
- **Last updated:** 08/22/2020