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Individual

JAMIE D GOAD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
710 AVENUE E, CARRIZOZO, NM 88301
(505) 648-2839
(505) 648-4113
Mailing address
5901 HARPER DR NE, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87109-3587
(505) 823-8528
(505) 823-8555

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD1324
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
84285
NM
Enumeration date
07/25/2006
Last updated
07/08/2007
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