Active NPI
Stephanie Louise Lake, D.D.S.
- Dentist
- Omaha, NE
National Provider Identifier
1124064803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6558
- Practice address
- 17110 Lakeside Hills PLZ
Omaha, NE 68130-5600 - Phone
- (402) 718-8737
- NPI assigned
- Jun 21, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 6558 | NE | Primary |
Addresses
Primary practice location
17110 Lakeside Hills PLZ
Omaha, NE 68130-5600
Mailing address
2612 N 179TH St
Omaha, NE 68116-2267
Phone (492) 733-1325
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160411001133 | NE | Order and Referring Only - Other (Non-Physician) | 8729386677 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6558 | NE | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686873600000",
"number": "1124064803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2612 N 179TH ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681162267",
"telephone_number": "492-733-1325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17110 LAKESIDE HILLS PLZ",
"city": "OMAHA",
"state": "NE",
"postal_code": "681305600",
"telephone_number": "402-718-8737"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAKE",
"first_name": "STEPHANIE",
"middle_name": "LOUISE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-21",
"last_updated": "2023-06-16",
"certification_date": "2023-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NE",
"license": "6558",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.