Basic Information
| Provider Information | |||||||||
| NPI: | 1770531303 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLOUD | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | LLOYD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2953 PLAZA AZUL | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875075337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054380328 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | BIA ROUTE 125 | ||||||||
| Address2: | |||||||||
| City: | PINE HILL | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057753271 | ||||||||
| FaxNumber: | 5057753633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DD2019 | NM | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | E6427 | 05 | NM | MEDICAID |