NPIMap

Organization Active NPI

Wildwind Dental

  • Dentist
  • Los Alamos, NM
National Provider Identifier
1629290283
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
1668 Issued in NM
Legal business name
WILDWIND DENTAL
Practice address
111 Longview Drive
Suite B3
Los Alamos, NM 87544
Phone
(505) 672-2020
Fax
(505) 672-2020
NPI assigned
May 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Ellen Vandergust Ballard, DDSNPI 1649452129
Title
President Wildwind Dental
Phone
(505) 672-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 1668 NM Primary

Addresses

Primary practice location

111 Longview Drive
Suite B3
Los Alamos, NM 87544

Mailing address

203 Rio Bravo
Los Alamos, NM 87544
Phone (505) 920-1065

Other names 1

  • Ellen Ballard DDS Doing business as

National Provider Directory

National Provider Directory

Locations

111 Longview Dr
Ste B3
White Rock, NM 87547
Phone (505) 672-2020

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629290283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 RIO BRAVO",
            "city": "LOS ALAMOS",
            "state": "NM",
            "postal_code": "87544",
            "telephone_number": "505-920-1065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 LONGVIEW DRIVE",
            "address_2": "SUITE B3",
            "city": "LOS ALAMOS",
            "state": "NM",
            "postal_code": "87544",
            "telephone_number": "505-672-2020",
            "fax_number": "505-672-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDWIND DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BALLARD",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "VANDERGUST",
        "authorized_official_title_or_position": "PRESIDENT WILDWIND DENTAL",
        "authorized_official_telephone_number": "505-672-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NM",
            "license": "1668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellen Ballard DDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Alamos, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.