Individual
DR. KEON J AHGHAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
824 N MAIN ST, ROSWELL, NM 88201-4969
(575) 622-4455
(575) 624-2556
Mailing address
824 N MAIN ST, ROSWELL, NM 88201-4969
(575) 622-4455
(575) 624-2556
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DD4275
NM
1223G0001X
General Practice Dentistry
DD4275
NM
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DD4275
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01350731
—
NM
Enumeration date
04/14/2014
Last updated
04/11/2024
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