San Juan Oral & Facial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

SAN JUAN ORAL & FACIAL SURGERY

Practice address

2990 E Pinon Frontage Rd Ste 102
Farmington, NM 87402-5068

Phone

(505) 333-8635

Fax

(505) 258-4909

NPI assigned

Sep 18, 2014

Last updated

Mar 3, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Beverly K Bradford, DDS

Title

Office Manager

Phone

(505) 333-8635

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1410998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614729600000",
    "number": "1104228329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2990 E PINON FRONTAGE RD STE 102",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874025068",
            "telephone_number": "505-333-8635",
            "fax_number": "505-258-4909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2990 E PINON FRONTAGE RD STE 102",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874025068",
            "telephone_number": "505-333-8635",
            "fax_number": "505-258-4909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JUAN ORAL & FACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-18",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A",
        "authorized_official_last_name": "BRADFORD",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "505-333-8635",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "27077748",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• San Juan Medical Group PC (Farmington Family Practice)
• San Juan Miners' Association
• San Juan Nephrology
• San Juan Obstetrics & Gynecology, LLC
• San Juan Oncology Associates, PC
• San Juan Regional Kidney Care,LLC
• San Juan Regional Medical Center Inc (San Juan Regional Urology)
• San Juan Regional Medical Center Inc (SJRMC Surgery 1st Assists)
• San Juan Regional Medical Center Inc (San Juan Regional Cardiology)
• San Juan Regional Medical Center Inc (San Juan Pediatrics)

• Oral and Maxillofacial Surgery (Dentist) in Farmington, NM
• Providers in Farmington, NM by specialty
• Oral and Maxillofacial Surgery (Dentist) in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.