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WESTSIDE PEDIATRIC DENTISTRY
NPI 1790808111
Dentist - Pediatric Dentistry in Rio Rancho, NM

Active since April 09, 2007
1724 GRANDE BLVD SE, RIO RANCHO, NM 87124(505) 896-0245(505) 892-7579 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Westside Pediatric Dentistry NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WESTSIDE PEDIATRIC DENTISTRY (NPI 1790808111) is a healthcare organization registered as a pediatric dentistry in Rio Rancho, New Mexico and active in the NPI registry since April 2007. The organization lists Raymond Eddie Broussard, Owner, as its authorized official.

NPPES Registry Identity

NPI1790808111
Entity TypeOrganization
Primary Taxonomy1223P0221X
Legal Business NameWESTSIDE PEDIATRIC DENTISTRY
Location Address1724 GRANDE BLVD SERio Rancho, NM 87124-1726
Mailing Address1724 Grande Blvd SeRio Rancho, NM 87124-1726 · (505) 896-0245 · Fax (505) 892-7579
Phone(505) 896-0245
Fax(505) 892-7579
Organization SubpartNo
Authorized OfficialRaymond Eddie BroussardOwner · (505) 896-0245
Enumeration DateApril 9, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1790808111 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
License✔ Licensed in NM · 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.
1724 GRANDE BLVD SE, Rio Rancho, NM 87124
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Other Identifiers 1

Medicaid83918NM

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Westside Pediatric Dentistry's NPI number?

The NPI number for Westside Pediatric Dentistry is 1790808111. It was assigned to this organization in the NPPES registry on April 9, 2007.

Where is Westside Pediatric Dentistry located?

Westside Pediatric Dentistry is located at 1724 Grande Blvd SE, Rio Rancho, NM 87124. The listed phone number is (505) 896-0245.

What is Westside Pediatric Dentistry's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

When was this NPI record last updated?

The NPPES record for Westside Pediatric Dentistry was last updated on August 22, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.