Individual
DR. THOMAS JAMES LONGWILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
306 W TILDEN ST, ROSWELL, NM 88203-4544
(575) 623-3204
(575) 625-2071
Mailing address
306 W TILDEN ST, ROSWELL, NM 88203-4544
(575) 623-3204
(575) 625-2071
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1528
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016994
—
NM
01
—
851955
PROVIDER ID
NM
Enumeration date
08/15/2005
Last updated
01/25/2016
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