Individual
JEREMY LANE HIXSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4760 N BUTLER AVE, SUITE A, FARMINGTON, NM 87401-0816
(505) 325-8858
Mailing address
243 N SALINA AVE, EAGLE, ID 83616-6899
(214) 693-4290
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DD3993
NM
Other
Enumeration date
07/22/2009
Last updated
07/29/2014
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