Individual
DR. MICHAEL J FANNING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.D.
Contact information
Practice address
8212 LOUISIANA BLVD NE STE A, ALBUQUERQUE, NM 87113-2105
(505) 400-9855
Mailing address
5507 EAKES RD NW, LOS RANCHOS, NM 87107-5529
(505) 400-9855
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DD3356
NM
Other
Enumeration date
11/24/2011
Last updated
11/24/2011
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