OrganizationActive
Westside Pediatric Dentistry
NPI 1790808111 · Pediatric Dentistry · Rio Rancho, NM
Westside Pediatric Dentistry is a Pediatric Dentistry organization in Rio Rancho, NM (NPI 1790808111).
Provider details
- NPI number
- 1790808111
- Entity type
- Organization
- Primary specialty
- Pediatric DentistryDental Providers
- Organization subpart
- No
- Authorized official
- Raymond Broussard, Owner(505) 896-0245
- License
- DD1745 (NM)
Specialties & taxonomies
Dental Providers
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1724 Grande Blvd Se
Rio Rancho, NM 87124-1726
Phone: (505) 896-0245
Fax: (505) 892-7579
Street-level locationGet directions
Mailing address
1724 Grande Blvd Se
Rio Rancho, NM 87124-1726
Registry dates
- Enumerated
- 2007-04-09
- Last updated
- 2020-08-22
Frequently asked questions
- What is Westside Pediatric Dentistry's NPI number?
- Westside Pediatric Dentistry's National Provider Identifier (NPI) is 1790808111, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Westside Pediatric Dentistry?
- Westside Pediatric Dentistry is classified in the NPPES registry as Pediatric Dentistry (Dental Providers).
- Where is Westside Pediatric Dentistry located?
- Westside Pediatric Dentistry's practice location on file with NPPES is 1724 Grande Blvd Se, Rio Rancho, NM 87124-1726.
- What is Westside Pediatric Dentistry's phone number?
- The practice phone number listed in the NPPES registry for Westside Pediatric Dentistry is (505) 896-0245.
- Who is the authorized official for Westside Pediatric Dentistry?
- The authorized official listed on Westside Pediatric Dentistry's NPPES record is Raymond Broussard, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Westside Pediatric Dentistry's NPI active?
- Yes — Westside Pediatric Dentistry's NPI (1790808111) is active in the NPPES registry as of the last update on 2020-08-22.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.