NPIMap

Individual provider Active NPI

Edward D Lacy, D.M.D., P.C.

  • General Practice Dentistry
  • Tualatin, OR
National Provider Identifier
1104076926
Registry record updated Sep 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D4844 Issued in OR
Practice address
8220 SW Warm Springs St
Suite 200
Tualatin, OR 97062-9338
Phone
(503) 692-0337
Fax
(503) 692-0792
NPI assigned
Sep 29, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D4844 OR Primary

Addresses

Primary practice location

8220 SW Warm Springs St
Suite 200
Tualatin, OR 97062-9338

Mailing address

8220 SW Warm Springs St
Suite 200
Tualatin, OR 97062-9338
Phone (503) 692-0337

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
D4844ORMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Warm Springs Dental, LLC General Practice Past Accepting new patients
Edward D. Lacy, DMD. Fagd, PC General Practice Past Accepting new patients

Organizations & group practices 2

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": "1222646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222646400000",
    "number": "1104076926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8220 SW WARM SPRINGS ST",
            "address_2": "SUITE 200",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970629338",
            "telephone_number": "503-692-0337",
            "fax_number": "503-692-0792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8220 SW WARM SPRINGS ST",
            "address_2": "SUITE 200",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970629338",
            "telephone_number": "503-692-0337",
            "fax_number": "503-692-0792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACY",
        "first_name": "EDWARD",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.M.D., P.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-29",
        "last_updated": "2008-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D4844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tualatin, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.

Verify at the official NPI Registry.