Westside Pediatric Dentistry

LBN: Westside Pediatric Dentistry
Westside Pediatric Dentistry is an health care organization with primary practice located at 1724 Grande Blvd Se , Rio Rancho NM 87124-1726. The organization recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as the primary health care specialty. Westside Pediatric Dentistry can be contacted via phone (505) 896-0245, or through Broussard, Raymond Eddie via phone (505) 896-0245.

Contact Information

Primary practice address
1724 Grande Blvd Se Rio Rancho NM 87124-1726
Phone: (505) 896-0245
Fax: (505) 892-7579
Website:
Map and Directions
Authorized official contact:
Name: Broussard, Raymond Eddie Doctor of Dental Surgery (DDS)
Phone: (505) 896-0245

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Pediatric Dentistry 1223P0221X DD1745 New Mexico

Profile Details

NPI number 1790808111
LBN Legal business name Westside Pediatric Dentistry
DBA Doing business as
Authorized official Broussard, Raymond Eddie Doctor of Dental Surgery (DDS)
Entity Organization
Organization subpart 1 No
Enumeration date Apr 9th, 2007
Last updated Aug 22nd, 2020 - about 6 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790808111 NPPES
New Mexico MEDICAID 83918

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