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SAN JUAN ORAL & FACIAL SURGERY
NPI 1104228329
Dentist - Oral and Maxillofacial Surgery in Farmington, NM

Active since September 18, 2014
2990 E PINON FRONTAGE RD STE 102, FARMINGTON, NM 87402(505) 333-8635(505) 258-4909 Get Directions Write a Review

NPPES record last updated: March 3, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About San Juan Oral & Facial Surgery NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAN JUAN ORAL & FACIAL SURGERY (NPI 1104228329) is a healthcare organization registered as an oral and maxillofacial surgery in Farmington, New Mexico and active in the NPI registry since September 2014. The organization lists Beverly K Bradford, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1104228329
Entity TypeOrganization
Primary Taxonomy1223S0112X
Legal Business NameSAN JUAN ORAL & FACIAL SURGERY
Location Address2990 E PINON FRONTAGE RD STE 102Farmington, NM 87402-5068
Mailing Address2990 E Pinon Frontage Rd Ste 102Farmington, NM 87402-5068 · (505) 333-8635 · Fax (505) 258-4909
Phone(505) 333-8635
Fax(505) 258-4909
Organization SubpartNo
Authorized OfficialBeverly K BradfordOffice Manager · (505) 333-8635
Enumeration DateSeptember 18, 2014
Last NPPES UpdateMarch 3, 2021
NPPES CertifiedMarch 3, 2021
✔ NPI 1104228329 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
2990 E PINON FRONTAGE RD STE 102, Farmington, NM 87402
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Other Identifiers 1

Medicaid27077748NM

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is San Juan Oral & Facial Surgery's NPI number?

The NPI number for San Juan Oral & Facial Surgery is 1104228329. It was assigned to this organization in the NPPES registry on September 18, 2014.

Where is San Juan Oral & Facial Surgery located?

San Juan Oral & Facial Surgery is located at 2990 E Pinon Frontage Rd Ste 102, Farmington, NM 87402. The listed phone number is (505) 333-8635.

What is San Juan Oral & Facial Surgery's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

When was this NPI record last updated?

The NPPES record for San Juan Oral & Facial Surgery was last updated on March 3, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.