Lonnie M Sibley Jr., DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

104233 Issued in CO

Practice address

4155 Darley Ave
Boulder, CO 80305-6536

Phone

(303) 499-7072

Fax

(303) 200-7375

NPI assigned

Nov 30, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dental Aid, Inc

  • General Practice Dentistry
  • Louisville, CO
  • NPI 1568473858
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465948800000",
    "number": "1033287115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1285 CENTAUR VILLAGE DR",
            "address_2": "SUITE 200",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800261214",
            "telephone_number": "720-287-2614",
            "fax_number": "303-200-7375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4155 DARLEY AVE",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803056536",
            "telephone_number": "303-499-7072",
            "fax_number": "303-200-7375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIBLEY",
        "first_name": "LONNIE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2016-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CO",
            "license": "104233",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "LA",
            "license": "2759",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02042331",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mitchell Shuman
• Erica Shure, MA, LPCC
• Mark Shusterman, M.D.
• Sarah Rose Shuwarger
• Maurieke D. Shyelle, M.D.
• Paul A Sica III, D.M.D.
• Molly Sicard, ATC
• Jeffrey Scott Sidders
• Lodi Siefer
• Evan Siegel

• Oral and Maxillofacial Surgery (Dentist) in Boulder, CO
• Providers in Boulder, CO by specialty
• Oral and Maxillofacial Surgery (Dentist) in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.