Organization
JEREMY W BURGIN, DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANAE D. THORN (OFFICE MANAGER)
(575) 762-2355
Entity
Organization
Contact information
Practice address
821 LEXINGTON RD STE A, CLOVIS, NM 88101-4466
(575) 762-2355
(575) 762-9573
Mailing address
821A LEXINGTON RD, CLOVIS, NM 88101-4466
(575) 762-2355
(575) 762-9573
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124581426
PRIVATE PRACTICE
NM
Enumeration date
11/18/2022
Last updated
11/18/2022
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