Organization
BOSQUE801
Active
Other names
Bosque Dental
Organization subpart
No
Provider details
NPI number
Authorized official
RAFAEL RASCON (DENTIST)
(801) 949-0273
Entity
Organization
Contact information
Practice address
3613 HIGHWAY 528 NW STE G, ALBUQUERQUE, NM 87114-8918
(505) 898-8011
Mailing address
3530 ESCARPA DR NW, ALBUQUERQUE, NM 87120-1511
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063030393
—
NM
Enumeration date
07/09/2025
Last updated
07/18/2025
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