Active NPI
Jamie Lazin, DMD, MS, MSD
- Orthodontics and Dentofacial Orthopedics Dentistry
- Indianapolis, IN
National Provider Identifier
1043661028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 12012549A
- Practice address
- 11 E 58TH St
Indianapolis, IN 46220-2519 - Phone
- (404) 931-1576
- NPI assigned
- Jun 30, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 12012549A | IN | Primary |
Addresses
Primary practice location
11 E 58TH St
Indianapolis, IN 46220-2519
Mailing address
11 E 58TH St
Indianapolis, IN 46220-2519
Phone (404) 931-1576
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1201549A | Other | IN | DENTAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12012549A | IN | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467244800000",
"number": "1043661028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 E 58TH ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462202519",
"telephone_number": "404-931-1576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 E 58TH ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462202519",
"telephone_number": "404-931-1576"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAZIN",
"first_name": "JAMIE",
"name_prefix": "Dr.",
"credential": "DMD, MS, MSD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-06-30",
"last_updated": "2016-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "IN",
"license": "12012549A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE",
"identifier": "1201549A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 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.