| Southern Blvd Dental Corp, Pa | |
|
2716 Southern Blvd Se Rio Rancho NM 87124-3741 | |
| (505) 892-8600 | |
| (505) 892-4215 |
| Full Name | Southern Blvd Dental Corp, Pa |
|---|---|
| Speciality | Dentist |
| Location | 2716 Southern Blvd Se, Rio Rancho, New Mexico |
| Authorized Official Name and Position | Martin G Goebbel (PRESIDENT/OWNER) |
| Authorized Official Contact | 5058928600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Blvd Dental Corp, Pa 2716 Southern Blvd Se Rio Rancho NM 87124-3741 Ph: (505) 892-8600 | Southern Blvd Dental Corp, Pa 2716 Southern Blvd Se Rio Rancho NM 87124-3741 Ph: (505) 892-8600 |
| NPI Number | 1316963739 |
|---|---|
| Provider Enumeration Date | 07/15/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 7214213909 |
|---|---|
| Medicare Enrollment ID | O20170412000832 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316963739 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DD1523 (New Mexico) | Secondary |
| 1223G0001X | Dentist - General Practice | DD1498 (New Mexico) | Primary |
| Provider Name | Martin George Goebbel |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1669507737 PECOS PAC ID: 9830416403 Enrollment ID: I20170412000928 |
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