Santa Fe Oral Surgery, LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DD3886 Issued in NM

Legal business name

SANTA FE ORAL SURGERY, LLC

Practice address

2100 Calle Dela Vueila Ste B103
B103
Santa Fe, NM 87505-4749

Phone

(505) 984-0694

Fax

(505) 983-3270

NPI assigned

Dec 17, 2013

Organization subpart

No

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

Authorized official

Name

Mrs. Rebecca J Martinez, DDS/MD

Title

Practice Manager

Phone

(505) 984-0694

Specialties & licenses 1

Addresses

Other names 1

• Sante Fe Oral Surgery LLC Other name

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

{
    "created_epoch": "1387238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577318400000",
    "number": "1508287541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 CALLE DELA VUEILA STE B103",
            "address_2": "B103",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875054749",
            "telephone_number": "505-984-0694",
            "fax_number": "505-983-3270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 CALLE DELA VUEILA STE B103",
            "address_2": "B103",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875054749",
            "telephone_number": "505-984-0694",
            "fax_number": "505-983-3270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA FE ORAL SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-17",
        "last_updated": "2019-12-26",
        "certification_date": "2019-12-26",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "505-984-0694",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DDS/MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NM",
            "license": "DD3886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sante Fe Oral Surgery LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Oral and Maxillofacial Surgery (Dentist) in Santa Fe, NM
• Providers in Santa Fe, 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 Dec 26, 2019; 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.