Individual
DR. JOHN WILLIAM BOUTZ
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
7111 PROSPECT PL NE, SUITE C, ALBUQUERQUE, NM 87110-4309
(505) 883-5773
Mailing address
7111 PROSPECT PL NE, SUITE C, ALBUQUERQUE, NM 87110-4309
(505) 883-5773
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DD964
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80838
—
NM
Enumeration date
12/07/2005
Last updated
07/09/2007
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