WESTSIDE PEDIATRIC DENTISTRY NPI 1790808111

NPI Information

WESTSIDE PEDIATRIC DENTISTRY is a pediatric dentistry dentist in Rio Rancho, NM. The provider is 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. WESTSIDE PEDIATRIC DENTISTRY NPI is 1790808111. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1724 GRANDE BLVD SE
RIO RANCHO, NM
ZIP 87124-726
Phone: (505) 896-0245
Fax: (505) 892-7579

The provider's authorized official is Raymond Eddie Broussard .
The authorized official title is Owner and has the following contact phone number (505) 896-0245.

The enumeration date for this NPI number is 4/9/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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