Active NPI
Jeffrey Lysdale, D.D.S.
- Dentist
- Laughlin, NV
National Provider Identifier
1083825004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4186
- Practice address
- 2311 S Casino Dr Ste D
Laughlin, NV 89029-1534 - Phone
- (702) 298-4545
- NPI assigned
- May 24, 2007
- Last updated
- Aug 20, 2008
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 4186 | NV | Primary |
Addresses
Primary practice location
2311 S Casino Dr Ste D
Laughlin, NV 89029-1534
Mailing address
1830 Kirk Drive
Lake Havasu City, AZ 86404
Phone (949) 351-7343
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
| License | State | Type | Specialty |
|---|---|---|---|
| 4186 | NV | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219190400000",
"number": "1083825004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1830 KIRK DRIVE",
"city": "LAKE HAVASU CITY",
"state": "AZ",
"postal_code": "86404",
"telephone_number": "949-351-7343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2311 S CASINO DR STE D",
"city": "LAUGHLIN",
"state": "NV",
"postal_code": "890291534",
"telephone_number": "702-298-4545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYSDALE",
"first_name": "JEFFREY",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-24",
"last_updated": "2008-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NV",
"license": "4186",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Laughlin, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.