De Baca Family Practice Clinic
De Baca Family Practice Clinic is a Dental Clinic/Center in Santa Rosa, New Mexico. Licensed in New Mexico. Registered with an NPI since 2013.
- Licensed in
- NM
- In the registry since
- 2013
- Specialties on file
- 2
Practice location Address checks out
552 US Hwy 54Santa Rosa, NM 88435
Phone: (575) 472-2414
Fax: (575) 472-2416
Show map & directions
Directions in Google Maps · Apple Maps · OpenStreetMap
Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Federally Qualified Health Center (FQHC) (primary) | Taxonomy 261QF0400X |
|---|---|
| Dental Clinic/Center | Taxonomy 261QD0000X (NM) |
Record details
| NPI number | 1962743534 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | Yes |
| Parent organization | De Baca Family Practice Clinic |
| Authorized official | Lisa Walraven — Ceo · (575) 355-2420 |
| Other names | Guadalupe Family Dental |
| NPI enumerated | March 7, 2013 |
| Last updated in NPPES | February 1, 2018 |
| Mailing address | Po Box 349, Fort Sumner, NM 88119-0349 |