| Dhhs Phs Ihs Acl Laguna Dental Clinic | |
|
State Rd #124 Exit 108 Off I-40 3 Mi North Laguna Dental Clinic New Laguna NM 87038 | |
| (505) 552-6645 | |
| Not Available |
| Full Name | Dhhs Phs Ihs Acl Laguna Dental Clinic |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | State Rd #124 Exit 108 Off I-40 3 Mi North, New Laguna, New Mexico |
| Authorized Official Name and Position | William R Thorne (ACL IHS CEO) |
| Authorized Official Contact | 5055525301 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dhhs Phs Ihs Acl Laguna Dental Clinic Acoma Canoncito Laguna Indian Hospital Po Box 130 San Fidel NM 87049 Ph: (505) 552-5385 | Dhhs Phs Ihs Acl Laguna Dental Clinic State Rd #124 Exit 108 Off I-40 3 Mi North Laguna Dental Clinic New Laguna NM 87038 Ph: (505) 552-6645 |
| NPI Number | 1558436261 |
|---|---|
| Provider Enumeration Date | 11/21/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558436261 | NPI | - | NPPES |
| H3451 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |