NPIMap

Organization Active NPI

Sundance Dental Care of Rio Rancho, LLC

  • Dentist
  • Rio Rancho, NM
National Provider Identifier
1164725503
Registry record updated Jun 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DD2287 Issued in NM
Legal business name
SUNDANCE DENTAL CARE OF RIO RANCHO, LLC
Practice address
770 Broadmoor Blvd NE
Rio Rancho, NM 87124
Phone
(505) 891-0554
Fax
(505) 891-0552
NPI assigned
Dec 7, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michelle Brown
Title
Manager
Phone
(505) 326-6800

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X DD2287 NM Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X DD2872 NM
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X DD3016 NM

Addresses

Primary practice location

770 Broadmoor Blvd NE
Rio Rancho, NM 87124

Mailing address

770 Broadmoor Blvd. NE
Rio Rancho, NM 87124
Phone (505) 891-0554

Other identifiers 6

IdentifierTypeStateIssuer
1093982027MedicaidNM
1447415849MedicaidNM
1578721718MedicaidNM
1316070303MedicaidNM
1659369700MedicaidNM
1437146768MedicaidNM

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1291680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402963200000",
    "number": "1164725503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 BROADMOOR BLVD. NE",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "87124",
            "telephone_number": "505-891-0554",
            "fax_number": "505-891-0552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 BROADMOOR BLVD NE",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "87124",
            "telephone_number": "505-891-0554",
            "fax_number": "505-891-0552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNDANCE DENTAL CARE OF RIO RANCHO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-07",
        "last_updated": "2014-06-17",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "505-326-6800"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD2287",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD2872",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD3016",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093982027",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447415849",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1578721718",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316070303",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1659369700",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1437146768",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rio Rancho, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.