Westside Pediatric Dentistry
Pediatric Dental Clinic
1724 Grande Blvd Se, Rio Rancho
New Mexico, 87124-1726
505-896-0245 505-892-7579
Maps & DirectionsWestside Pediatric Dentistry is a Pediatric Dental Clinic in Rio Rancho, New Mexico. It is located at 1724 Grande Blvd Se, Rio Rancho, NM and its contact number is 505-896-0245. The authorized person for Westside Pediatric Dentistry is Dr. Raymond Eddie Broussard
who is Owner of the clinic and their contact number is 505-896-0245. The primary license number for Westside Pediatric Dentistry is DD1745 (Pediatric Dentistry) in New Mexico.
Westside Pediatric Dentistry Clinic provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
Complete Clinic Profile:
Westside Pediatric Dentistry Clinic speciality, address, contact phone number and fax are as below.
Patients can call on the below given phone number for appointments.
| Name: | Westside Pediatric Dentistry |
| Specialization: | Pediatric Dentistry |
| Clinic Address: | 1724 Grande Blvd Se, Rio Rancho,
New Mexico, 87124-1726 |
| Phone: | 505-896-0245 |
| Fax: | 505-892-7579 |
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints for this clinic are as below. Person's position and contact details are also mentioned below.
| Name: | Dr. Raymond Eddie Broussard |
| Position: | Owner |
| Contact Number: | 505-896-0245 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details for Westside Pediatric Dentistry clinic are as mentioned below.
| NPI Number: | 1790808111 |
| NPI Enumeration Date: | 09 Apr, 2007 |
| NPI Last Update On: | 22 Aug, 2020 |
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Westside Pediatric Dentistry are as mentioned below.
| Specialization | License Number | State | Status | |
| Pediatric Dentistry | DD1745 | New Mexico | Primary | |
Other Medical Identifiers:
Other legacy medical identifiers of the clinic such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 83918 | Medicaid | New Mexico | |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | Westside Pediatric Dentistry
1724 Grande Blvd Se,
Rio Rancho, New Mexico |
| Zip: | 87124-1726 |
| Phone Number: | 505-896-0245 |
| Fax Number: | 505-892-7579 |
Patients can reach Westside Pediatric Dentistry at
1724 Grande Blvd Se, Rio Rancho, New Mexico or can
call to book an appointment on 505-896-0245.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on
08 December, 2025.