Organization
ADVANCED ENDODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES JAMES GOODIS DDS (OWNER)
(505) 797-1212
Entity
Organization
Contact information
Practice address
7520 MONTGOMERY BLVD, E1, ALBUQUERQUE, NM 87109
(505) 797-1212
(505) 823-1831
Mailing address
7520 MONTGOMERY BLVD, E1, ALBUQUERQUE, NM 87109
(505) 797-1212
(505) 823-1831
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
DD1759
NM
1223E0200X
Endodontics
Primary
DD1868
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004283
—
NM
Enumeration date
11/10/2005
Last updated
08/22/2020
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