Provider Demographics
NPI:1770531303
Name:CLOUD, WILLIAM LLOYD JR (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LLOYD
Last Name:CLOUD
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2953 PLAZA AZUL
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-5337
Mailing Address - Country:US
Mailing Address - Phone:505-438-0328
Mailing Address - Fax:
Practice Address - Street 1:BIA ROUTE 125
Practice Address - Street 2:
Practice Address - City:PINE HILL
Practice Address - State:NM
Practice Address - Zip Code:87357
Practice Address - Country:US
Practice Address - Phone:505-775-3271
Practice Address - Fax:505-775-3633
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD20191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME6427Medicaid