Individual provider Active NPI

Robert Stephen Vanlaecken, D.D.S.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Watertown, SD
National Provider Identifier
1063711109
Registry record updated May 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
D0925 Issued in SD
Practice address
600 4TH St NE Ste 103
Watertown, SD 57201-1898
Phone
(605) 882-1500
Fax
(605) 882-7090
NPI assigned
Mar 15, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X D0925 SD Primary

Addresses

Primary practice location

600 4TH St NE Ste 103
Watertown, SD 57201-1898

Mailing address

600 4TH St NE Ste 103
Watertown, SD 57201-1898
Phone (605) 882-1500

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

State licenses

LicenseStateTypeSpecialty
D0925SDMDOrthodontics and Dentofacial Orthopedic Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Orthodontic Associates. L.L.C. Orthodontics and Dentofacial Orthopedics 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.

NPI Registry JSON

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

{
    "created_epoch": "1300147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589760000000",
    "number": "1063711109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 4TH ST NE STE 103",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572011898",
            "telephone_number": "605-882-1500",
            "fax_number": "605-882-7090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 4TH ST NE STE 103",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572011898",
            "telephone_number": "605-882-1500",
            "fax_number": "605-882-7090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANLAECKEN",
        "first_name": "ROBERT",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-15",
        "last_updated": "2020-05-18",
        "certification_date": "2020-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "SD",
            "license": "D0925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2020; 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.