| Sundance Dental Care Of Rio Rancho, Llc | |
|
770 Broadmoor Blvd Ne Rio Rancho NM 87124 | |
| (505) 891-0554 | |
| (505) 891-0552 |
| Full Name | Sundance Dental Care Of Rio Rancho, Llc |
|---|---|
| Speciality | Dentist |
| Location | 770 Broadmoor Blvd Ne, Rio Rancho, New Mexico |
| Authorized Official Name and Position | Michelle Brown (MANAGER) |
| Authorized Official Contact | 5053266800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sundance Dental Care Of Rio Rancho, Llc 770 Broadmoor Blvd. Ne Rio Rancho NM 87124 Ph: (505) 891-0554 | Sundance Dental Care Of Rio Rancho, Llc 770 Broadmoor Blvd Ne Rio Rancho NM 87124 Ph: (505) 891-0554 |
| NPI Number | 1164725503 |
|---|---|
| Provider Enumeration Date | 12/07/2010 |
| Last Update Date | 06/17/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164725503 | NPI | - | NPPES |
| 1093982027 | Medicaid | NM | |
| 1447415849 | Medicaid | NM | |
| 1578721718 | Medicaid | NM | |
| 1316070303 | Medicaid | NM | |
| 1659369700 | Medicaid | NM | |
| 1437146768 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DD2287 (New Mexico) | Primary |
| 122300000X | Dentist | DD2872 (New Mexico) | Secondary |
| 122300000X | Dentist | DD3016 (New Mexico) | Secondary |
Westside Endodontics Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2320 Grande Blvd Se, Suite A, Rio Rancho, NM 87124 Phone: 505-891-2100 | |
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