Provider Demographics
NPI:1114692209
Name:SMILE DOCTORS OF NEW MEXICO PC
Entity Type:Organization
Organization Name:SMILE DOCTORS OF NEW MEXICO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOGGANS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:806-794-8124
Mailing Address - Street 1:PO BOX 674456
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4456
Mailing Address - Country:US
Mailing Address - Phone:806-794-8124
Mailing Address - Fax:
Practice Address - Street 1:1215 W JOE HARVEY BLVD
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-0907
Practice Address - Country:US
Practice Address - Phone:806-794-8124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty