Organization
BEAR CANYON ORAL & FACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRAVIS CHARLES RUDD DDS (PRESIDENT)
(505) 292-3400
Entity
Organization
Contact information
Practice address
10151 MONTGOMERY NE STE 2-D, ALBUQUERQUE, NM 87111
(505) 292-3400
(505) 292-7124
Mailing address
10151 MONTGOMERY NE STE 2-D, ALBUQUERQUE, NM 87111
(505) 292-3400
(505) 292-7124
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
DD3881
NM
Other
Enumeration date
11/12/2013
Last updated
11/12/2013
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