# ROSWELL ORAL & FACIAL SURGERY, LLC

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

## Provider details

- **NPI number:** 1518351790
- **Authorized official:** DR. BRYCE HEINER DMD, MD (OWNER/SURGEON)
- **Authorized official phone:** (575) 522-8800

## Contact information

- **Practice address:** 207 N UNION AVE, STE E, ROSWELL, NM 88201-3068
- **Practice address phone:** (575) 623-5711
- **Practice address fax:** (575) 622-8922
- **Mailing address:** 2103 TELSHOR CT, LAS CRUCES, NM 88011-8245
- **Mailing address phone:** (575) 522-8800
- **Mailing address fax:** (575) 521-4448

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DD3068 | NM | Yes |

## Other

- **Enumeration date:** 03/25/2015
- **Last updated:** 03/25/2015