NPIMap

Organization Active NPI

Jack P Newell DDS a Professioal Corporation

  • Dentist
  • La Place, LA
National Provider Identifier
1043387160
Registry record updated Feb 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
3012 Issued in LA
Legal business name
JACK P NEWELL DDS A PROFESSIOAL CORPORATION
Practice address
179 Belle Terre Blvd
Suite C
La Place, LA 70068-3347
Phone
(985) 652-2425
Fax
(985) 651-7817
NPI assigned
Nov 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2010

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

Authorized official

Name
Dr. Jack P Newell, DDS
Title
Owner
Phone
(985) 652-2425

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 3012 LA Primary

Addresses

Primary practice location

179 Belle Terre Blvd
Suite C
La Place, LA 70068-3347

Mailing address

179 Belle Terre Blvd
Suite C
La Place, LA 70068-3347
Phone (985) 652-2425

Other identifiers 1

IdentifierTypeStateIssuer
1830127MedicaidLA

National Provider Directory

National Provider Directory

Locations

179 Belle Terre Blvd
Ste C
La Place, LA 70068
Phone (985) 652-2425

NPI Registry JSON

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267056000000",
    "number": "1043387160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "179 BELLE TERRE BLVD",
            "address_2": "SUITE C",
            "city": "LA PLACE",
            "state": "LA",
            "postal_code": "700683347",
            "telephone_number": "985-652-2425",
            "fax_number": "985-651-7817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "179 BELLE TERRE BLVD",
            "address_2": "SUITE C",
            "city": "LA PLACE",
            "state": "LA",
            "postal_code": "700683347",
            "telephone_number": "985-652-2425",
            "fax_number": "985-651-7817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK P NEWELL DDS A PROFESSIOAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2010-02-25",
        "status": "A",
        "authorized_official_last_name": "NEWELL",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "985-652-2425",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "LA",
            "license": "3012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1830127",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Place, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2010; 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.