NPIMap

Organization Active NPI

Oral and Maxillofacial Surgery Associate of New Mexico, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Albuquerque, NM
National Provider Identifier
1689876963
Registry record updated Jul 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
02-256180-00-3 Issued in NM
Legal business name
ORAL AND MAXILLOFACIAL SURGERY ASSOCIATE OF NEW MEXICO, P.A.
Practice address
6800 Montgomery Blvd NE
Suite a
Albuquerque, NM 87109-1405
Phone
(505) 881-1130
NPI assigned
May 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2009

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

Authorized official

Name
John C Mitchell, D.D.S.
Title
Managing Partner
Phone
(505) 881-1130

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X 02-256180-00-3 NM Primary

Addresses

Primary practice location

6800 Montgomery Blvd NE
Suite a
Albuquerque, NM 87109-1405

Mailing address

6800 Montgomery Blvd NE
Suite a
Albuquerque, NM 87109-1405
Phone (505) 881-1130

Other identifiers 1

IdentifierTypeStateIssuer
89797MedicaidNM

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247011200000",
    "number": "1689876963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 MONTGOMERY BLVD NE",
            "address_2": "SUITE A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871091405",
            "telephone_number": "505-881-1130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6800 MONTGOMERY BLVD NE",
            "address_2": "SUITE A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871091405",
            "telephone_number": "505-881-1130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL AND MAXILLOFACIAL SURGERY ASSOCIATE OF NEW MEXICO, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2009-07-08",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "505-881-1130",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NM",
            "license": "02-256180-00-3",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89797",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2009; 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.