Provider Demographics
NPI:1821583469
Name:SANTA FE ORAL AND FACIAL SURGERY
Entity Type:Organization
Organization Name:SANTA FE ORAL AND FACIAL SURGERY
Other - Org Name:BONITA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-988-2121
Mailing Address - Street 1:1700 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4763
Mailing Address - Country:US
Mailing Address - Phone:505-988-2121
Mailing Address - Fax:
Practice Address - Street 1:1700 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4763
Practice Address - Country:US
Practice Address - Phone:505-988-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty