Organization
ORAL AND MAXILLOFACIAL SURGERY ASSOCIATE OF NEW MEXICO, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN C MITCHELL D.D.S. (MANAGING PARTNER)
(505) 881-1130
Entity
Organization
Contact information
Practice address
6800 MONTGOMERY BLVD NE, SUITE A, ALBUQUERQUE, NM 87109-1405
(505) 881-1130
Mailing address
6800 MONTGOMERY BLVD NE, SUITE A, ALBUQUERQUE, NM 87109-1405
(505) 881-1130
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
02-256180-00-3
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89797
—
NM
Enumeration date
05/31/2007
Last updated
07/08/2009
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