Organization
SIMPLY DENTAL & ORAL SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH A WILSON DMD, MSD, LLC (OWNER)
(505) 360-9592
Entity
Organization
Contact information
Practice address
4760 N BUTLER AVE STE B1, FARMINGTON, NM 87401-0816
(505) 325-8858
Mailing address
4760 N BUTLER AVE STE B1, FARMINGTON, NM 87401-0816
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DD3399
NM
Other
Enumeration date
11/14/2014
Last updated
11/14/2014
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