Active NPI
David Lennard Paclibare Vizconde, DMD
- Dentist
- Evansville, IN
National Provider Identifier
1093373508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12013239A
- Practice address
- 508 N Green River Rd
Evansville, IN 47715-2412 - Phone
- (812) 618-9357
- NPI assigned
- May 30, 2019
- 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 | 12013239A | IN | Primary |
Addresses
Primary practice location
508 N Green River Rd
Evansville, IN 47715-2412
Mailing address
2305 Babcock Dr
Las Vegas, NV 89134-0167
Phone (562) 242-9091
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 |
|---|---|---|---|
| 12013239A | IN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564963200000",
"number": "1093373508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2305 BABCOCK DR",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891340167",
"telephone_number": "562-242-9091"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "508 N GREEN RIVER RD",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477152412",
"telephone_number": "812-618-9357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIZCONDE",
"first_name": "DAVID LENNARD",
"middle_name": "PACLIBARE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-05-30",
"last_updated": "2019-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12013239A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evansville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.