Westside Pediatric Dentistry in Rio Rancho - Pediatric Dentistry
Westside Pediatric Dentistry - NPI 1790808111
Westside Pediatric Dentistry is a Pediatric Dentistry in Rio Rancho, New Mexico. Westside Pediatric Dentistry practices all healthcare services and medical treatments related to Pediatric Dentistry. The NPI Number for Westside Pediatric Dentistry is 1790808111. The last update date is 2020-08-22.
Westside Pediatric Dentistry's current location address is 1724 Grande Blvd Se, Rio Rancho, New Mexico. You can contact this provider via phone number 5058960245 and fax number 5058927579. The mailing address for Westside Pediatric Dentistry is 1724 Grande Blvd Se, Rio Rancho, New Mexico. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Westside Pediatric Dentistry |
|---|---|
| Address | 1724 Grande Blvd Se, Rio Rancho, New Mexico |
| Phone Number | 5058960245 |
| Fax Number | 5058927579 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | OWNER |
|---|---|
| Authorized Official Name | Broussard Eddie Raymond |
| Credentials | DDS |
| Telephone Number | 5058960245 |
NPI Number Detail
| NPI Number | 1790808111 |
|---|---|
| Provider Enumeration Date | 2007-04-09 |
| Last Updated Date | 2020-08-22 |
Provider Mailing Address Detail
| Address | 1724 Grande Blvd Se |
|---|---|
| City | Rio Rancho |
| State | New Mexico (NM) |
| Post Code | 871241726 |
| Phone Number | 5058960245 |
| Fax Number | 5058927579 |
Provider's Primary Taxonomy Detail
| Speciality | Pediatric Dentistry |
|---|---|
| Taxonomy | 1223P0221X |
| Licence No | DD1745 |
|
Definition: An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 83918 | NM | -- |
Post Comment/ Review Below
What is the unique identifier code issued to Westside Pediatric Dentistry by the Centers for Medicare & Medicaid Services?
The Westside Pediatric Dentistry has been assigned the NPI (National Provider Identifier) 1790808111. This 10-digit code serves as a unique identification number for healthcare providers issued by the Centers for Medicare & Medicaid Services (CMS).
Could you kindly provide the complete physical address where Westside Pediatric Dentistry's facilities are geographically located?
The facilities of Westside Pediatric Dentistry are physically situated at the following location: 1724 Grande Blvd Se, Rio Rancho, NM, 871241726.
What is Westside Pediatric Dentistry's specialized area of practice, and what is the corresponding taxonomy classification code for this field?
The Westside Pediatric Dentistry's specialized field of practice is Pediatric Dentistry, and the corresponding taxonomy code that categorizes this area of specialization is 1223P0221X.
On what date did the Centers for Medicare & Medicaid Services assign the 1790808111 to Westside Pediatric Dentistry?
The Centers for Medicare & Medicaid Services assigned the 1790808111 to Westside Pediatric Dentistry on 2007-04-09.
When was the information pertaining to Westside Pediatric Dentistry most recently updated or revised?
The details related to Westside Pediatric Dentistry, including its address, specialty, and other relevant information, were last updated or revised on 2020-08-22.
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