# BEAR CANYON ORAL & FACIAL SURGERY

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

## Provider details

- **NPI number:** 1871922807
- **Authorized official:** DR. TRAVIS CHARLES RUDD DDS (PRESIDENT)
- **Authorized official phone:** (505) 292-3400

## Contact information

- **Practice address:** 10151 MONTGOMERY NE STE 2-D, ALBUQUERQUE, NM 87111
- **Practice address phone:** (505) 292-3400
- **Practice address fax:** (505) 292-7124
- **Mailing address:** 10151 MONTGOMERY NE STE 2-D, ALBUQUERQUE, NM 87111
- **Mailing address phone:** (505) 292-3400
- **Mailing address fax:** (505) 292-7124

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | DD3881 | NM | Yes |

## Other

- **Enumeration date:** 11/12/2013
- **Last updated:** 11/12/2013