NPIMap

Organization Active NPI

Grande Dentistry LLC

  • General Practice Dentistry
  • Rio Rancho, NM
National Provider Identifier
1972166262
Registry record updated Oct 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
GRANDE DENTISTRY LLC
Practice address
2200 Grande Blvd SE Ste a
Rio Rancho, NM 87124-1695
Phone
(505) 891-1500
NPI assigned
Apr 22, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2019

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

Authorized official

Name
Faith Gaskins
Title
Director of Credentialing
Phone
(972) 869-3789

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

2200 Grande Blvd SE Ste a
Rio Rancho, NM 87124-1695

Mailing address

2200 Grande Blvd SE Ste a
Rio Rancho, NM 87124-1695
Phone (972) 869-3789

Other names 1

  • Rio Rancho Dental Associates Doing business as

National Provider Directory

National Provider Directory

Locations

2200 Grande Blvd SE
Ste A
Rio Rancho, NM 87124
Phone (505) 891-1500

Practitioners & affiliated clinicians

Practitioners 5

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": "1555891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572393600000",
    "number": "1972166262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 GRANDE BLVD SE STE A",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241695",
            "telephone_number": "972-869-3789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 GRANDE BLVD SE STE A",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241695",
            "telephone_number": "505-891-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANDE DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-22",
        "last_updated": "2019-10-30",
        "status": "A",
        "authorized_official_last_name": "GASKINS",
        "authorized_official_first_name": "FAITH",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "972-869-3789"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rio Rancho Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 30, 2019; 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.