OrganizationActive
Westside Pediatric Dentistry
NPI 1790808111 · Pediatric Dentistry · Rio Rancho, NM
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
Practice location
1724 Grande Blvd Se
Rio Rancho, NM 87124-1726
Phone: (505) 896-0245
Fax: (505) 892-7579
Approximate (ZIP-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
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.