Individual
MR. RAYMOND EDDIE BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1724 GRANDE BLVD, RIO RANCHO, NM 87124
(505) 896-0245
(505) 892-7579
Mailing address
1724 GRANDE BLVD, RIO RANCHO, NM 87124
(505) 896-0245
(505) 892-7579
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD1745
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
83918
—
NM
Enumeration date
08/24/2006
Last updated
07/08/2007
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