Active NPI
Lamont Lewis Gillham, DDS
- General Practice Dentistry
- Bellevue, NE
National Provider Identifier
1063589703
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Feb 24, 2010.
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6469
- Practice address
- 1411 J F Kennedy Drive
Bellevue, NE 68005-3693 - Phone
- (402) 291-3535
- Fax
- (402) 291-0760
- NPI assigned
- Nov 29, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6469 | NE | Primary |
Addresses
Primary practice location
1411 J F Kennedy Drive
Bellevue, NE 68005-3693
Mailing address
1411 J F Kennedy Drive
Bellevue, NE 68005-3693
Phone (402) 291-3535
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6469 | NE | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kennedy Dental Associates, P.C. | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Bellevue, NE
- NPI 1679648521
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063589703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1411 J F KENNEDY DRIVE",
"city": "BELLEVUE",
"state": "NE",
"postal_code": "680053693",
"telephone_number": "402-291-3535",
"fax_number": "402-291-0760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1411 J F KENNEDY DRIVE",
"city": "BELLEVUE",
"state": "NE",
"postal_code": "680053693",
"telephone_number": "402-291-3535",
"fax_number": "402-291-0760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLHAM",
"first_name": "LAMONT",
"middle_name": "LEWIS",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NE",
"license": "6469",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bellevue, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.