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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
27077748
—
NM
Enumeration date
09/18/2014
Last updated
03/03/2021
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up