Guadalupe Family Dental
LBN: De Baca Family Practice Clinic
Guadalupe Family Dental is an health care organization with primary practice located at 552 Us Hwy 54 , Santa Rosa NM 88435. The organization recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Dental, Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC). Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) is the primary health care specialty.
De Baca Family Practice Clinic can be contacted via phone (575) 472-2414, or through Walraven, Lisa via phone (575) 355-2420.
Contact Information
Primary practice address
552 Us Hwy 54
Santa Rosa NM 88435
Phone: (575) 472-2414
Fax: (575) 472-2416
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Dental | 261QD0000X | New Mexico | |
| Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) | 261QF0400X |
Profile Details
| NPI number | 1962743534 |
|---|---|
| LBN Legal business name | De Baca Family Practice Clinic |
| DBA Doing business as | Guadalupe Family Dental |
| Authorized official | Walraven, Lisa |
| Entity | Organization |
| Organization subpart 1 | Yes |
| Enumeration date | Mar 7th, 2013 |
| Last updated | Feb 1st, 2018 - about 8 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1962743534 | NPPES |
| New Mexico | MEDICAID | 84331534 |
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