Organization
SOUTHERN BLVD DENTAL CORP, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARTIN G GOEBBEL DDS (PRESIDENT/OWNER)
(505) 892-8600
Entity
Organization
Contact information
Practice address
2716 SOUTHERN BLVD SE, RIO RANCHO, NM 87124-3741
(505) 892-8600
(505) 892-4215
Mailing address
2716 SOUTHERN BLVD SE, RIO RANCHO, NM 87124-3741
(505) 892-8600
(505) 892-4215
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD1498
NM
1223G0001X
General Practice Dentistry
DD1523
NM
Other
Enumeration date
07/15/2006
Last updated
08/22/2020
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