LAKE CITY DENTAL CLINIC NPI 1376143081

NPI Information

NPI: 1376143081
Provider Name: LAKE CITY DENTAL CLINIC
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

CLIA Number: 06D0644463

Address:
700 N HENSON ST
LAKE CITY, CO
ZIP 81235
Phone: (970) 944-2331
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LAKE CITY DENTAL CLINIC is a dental clinic center in Lake City, CO. LAKE CITY DENTAL CLINIC NPI is 1376143081. The provider is registered as an organization entity type.

The provider's business location address is:

700 N HENSON ST
LAKE CITY, CO
ZIP 81235-134
Phone: (970) 944-2331
Fax: (970) 944-2320

The provider's authorized official is Jessica Whiddon .
The authorized official title is Executive Director and has the following contact phone number (970) 944-2331.

The CLIA number assigned to this NPI record is 06D0644463 - rural health clinic with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 10/30/2020 and was last updated on 10/30/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	9000141620	MEDICAID	COLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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