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Contact Information

RAYMOND E BROUSSARD, DDS
1724 GRANDE BLVD
RIO RANCHO, NM87124
 Phone: 505-896-0245
 Fax: 505-892-7579
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
Indicates primary specialty

NPI Profile & details for RAYMOND E BROUSSARD · (Male)

NPI Number 1558478560
Status Active
Credentials DDS (Doctor of Dental Surgery)
Entity Individual
Enumeration date 08/24/2006
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 No
Identifiers
  • NM License # DD1745
  • NM Medicaid 83918
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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