Bosque801

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

BOSQUE801

Practice address

3613 Highway 528 NW Ste G
Albuquerque, NM 87114-8918

Phone

(505) 898-8011

NPI assigned

Jul 9, 2025

Organization subpart

No

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

Authorized official

Name

Rafael RasconNPI 1063030393

Title

Dentist

Phone

(801) 949-0273

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bosque Dental Doing business as

Practitioners 3

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

• Rafael Gonzalez Rascon, DDS

  • General Practice Dentistry
  • Albuquerque, NM
  • NPI 1063030393
  NPD Authorized official
• Guy Charles Clark, D.D.S. PA

  • General Practice Dentistry
  • Albuquerque, NM
  • NPI 1215948286
  NPD (past)
• Hollymae Lindsley, DDS

  • General Practice Dentistry
  • Santa Fe, NM
  • NPI 1700199932
  NPD (past)

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

{
    "created_epoch": "1752019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752796800000",
    "number": "1861382822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3530 ESCARPA DR NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871201511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3613 HIGHWAY 528 NW STE G",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871148918",
            "telephone_number": "505-898-8011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSQUE801",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-09",
        "last_updated": "2025-07-18",
        "certification_date": "2025-07-18",
        "status": "A",
        "authorized_official_last_name": "RASCON",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "801-949-0273"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063030393",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bosque Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bosque Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bosque Mental Health Associates, Inc.
• Bosque Smiles Dentistry, LLC
• Bosque Trails Assisted Living LLC
• Bosque Trails Hospice LLC
• Bosque Womens Care PC
• Mateo G Bosquez, MD
• Christopher Stephen Bossart, M.D.
• Staci Bostic, LCSW
• Everett Bostick
• David Jefferson Boston, LPCC

• General Practice Dentistry in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2025; 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.