Organization
DHHS PHS IHS ACL LAGUNA DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM R THORNE JR. (ACL IHS CEO)
(505) 552-5301
Entity
Organization
Contact information
Practice address
STATE RD #124 EXIT 108 OFF I-40 3 MI NORTH, LAGUNA DENTAL CLINIC, NEW LAGUNA, NM 87038
(505) 552-6645
Mailing address
ACOMA CANONCITO LAGUNA INDIAN HOSPITAL, PO BOX 130, SAN FIDEL, NM 87049
(505) 552-5385
(505) 552-5490
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
H3451
—
NM
Enumeration date
11/21/2006
Last updated
08/22/2020
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