555 W Elm St Dentistry LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30 . 20842 Issued in OH

Legal business name

555 W ELM ST DENTISTRY LLC

Practice address

555 W Elm St
Lima, OH 45801-4757

Phone

(419) 229-0776

Fax

(419) 229-3828

NPI assigned

Feb 10, 2007

Last updated

Mar 19, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Wayne HancockNPI 1154486850

Title

Owner

Phone

(419) 229-0776

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David W Hancock, D.D.S.

  • General Practice Dentistry
  • Lima, OH
  • NPI 1154486850
  NPD (past) Authorized official

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

{
    "created_epoch": "1171065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205884800000",
    "number": "1043351034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 W ELM ST",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458014757",
            "telephone_number": "419-229-0776",
            "fax_number": "419-229-3828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 W ELM ST",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458014757",
            "telephone_number": "419-229-0776",
            "fax_number": "419-229-3828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "555 W ELM ST DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-10",
        "last_updated": "2008-03-19",
        "status": "A",
        "authorized_official_last_name": "HANCOCK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "419-229-0776"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30 . 20842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2081376",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Lima, OH
• Providers in Lima, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2008; 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.