Organization
RIO RANCHO ORAL AND MAXILLOFACIAL SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURENCE J ROGEL DDS (PRESIDENT)
(505) 994-4772
Entity
Organization
Contact information
Practice address
1316 JACKIE ROAD SE, SUITE 600, RIO RANCHO, NM 87124-6606
(505) 994-4772
(505) 994-1925
Mailing address
P.O. BOX 45895, RIO RANCHO, NM 87174-5895
(505) 994-4772
(505) 994-1925
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
DD1538
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00085266
—
NM
Enumeration date
12/10/2010
Last updated
11/29/2018
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