Organization
ROSWELL ORAL & FACIAL SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYCE HEINER DMD, MD (OWNER/SURGEON)
(575) 522-8800
Entity
Organization
Contact information
Practice address
207 N UNION AVE, STE E, ROSWELL, NM 88201-3068
(575) 623-5711
(575) 622-8922
Mailing address
2103 TELSHOR CT, LAS CRUCES, NM 88011-8245
(575) 522-8800
(575) 521-4448
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DD3068
NM
Other
Enumeration date
03/25/2015
Last updated
03/25/2015
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