Provider Demographics
NPI:1013169614
Name:WESTSIDE ORAL SURGERY, PC
Entity Type:Organization
Organization Name:WESTSIDE ORAL SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:LARMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:505-899-6979
Mailing Address - Street 1:1628 ALAMEDA BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-8807
Mailing Address - Country:US
Mailing Address - Phone:505-899-6979
Mailing Address - Fax:505-899-6980
Practice Address - Street 1:1628 ALAMEDA BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-8807
Practice Address - Country:US
Practice Address - Phone:505-899-6979
Practice Address - Fax:505-899-6980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2870261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery