Provider Demographics
NPI:1992714075
Name:CLOUD, C DOUGLAS (DDS)
Entity type:Individual
Prefix:
First Name:C
Middle Name:DOUGLAS
Last Name:CLOUD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7910 WYOMING BLVD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6029
Mailing Address - Country:US
Mailing Address - Phone:505-296-9504
Mailing Address - Fax:505-296-0078
Practice Address - Street 1:7910 WYOMING BLVD NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6029
Practice Address - Country:US
Practice Address - Phone:505-296-9504
Practice Address - Fax:505-296-0078
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM14761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice