LAKE ROAD DENTAL LLC NPI 1174016737

Clinic/Center (Dental) in Dillingham, AK

NPI 1174016737 Organization Clinic/Center Dental

About LAKE ROAD DENTAL LLC

Lake Road Dental Llc is a provider established in Dillingham, Alaska specializing in clinic/center (dental) . The NPI number of Lake Road Dental Llc is 1174016737 and was assigned on June 2018. The practitioner's primary taxonomy code is 261QD0000X. The provider is registered as an organization and their NPI record was last updated 3 years ago. The authorized official of this NPI record is Kelly Lucas Dds (Dentist/ Owner)

NPI

1174016737

Provider NameLAKE ROAD DENTAL LLC
Provider Location Address4622 SHANNON LAKE RD DILLINGHAM, AK 99576
Provider Mailing AddressPO BOX 969 DILLINGHAM, AK 99576
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date06-08-2018
Last Update Date06-08-2018


Primary Taxonomy

Taxonomy Code261QD0000X
ClassificationClinic/Center
TypeAmbulatory Health Care Facilities
SpecializationDental

Business Address

LAKE ROAD DENTAL LLC
4622 SHANNON LAKE RD
DILLINGHAM, AK
ZIP 99576
Phone: (907) 842-2324

Get Directions


Mailing Address

LAKE ROAD DENTAL LLC
PO BOX 969
DILLINGHAM, AK
ZIP 99576
Phone: (907) 842-2324



Authorized Official

Authorized Official Name KELLY LUCAS DDS
Authorized Official TitleDENTIST/ OWNER
Authorized Official Phone(907) 842-2324

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.