Organization
SUNDANCE DENTAL CARE OF RIO RANCHO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE BROWN (MANAGER)
(505) 326-6800
Entity
Organization
Contact information
Practice address
770 BROADMOOR BLVD NE, RIO RANCHO, NM 87124
(505) 891-0554
(505) 891-0552
Mailing address
770 BROADMOOR BLVD. NE, RIO RANCHO, NM 87124
(505) 891-0554
(505) 891-0552
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD2287
NM
122300000X
Dentist
DD2872
NM
122300000X
Dentist
DD3016
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093982027
—
NM
05
—
1316070303
—
NM
05
—
1437146768
—
NM
05
—
1447415849
—
NM
05
—
1578721718
—
NM
05
—
1659369700
—
NM
Enumeration date
12/07/2010
Last updated
06/17/2014
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