Individual provider Active NPI

Lafaith Chivonne Miller, D.M.D

  • General Practice Dentistry
  • Lake Charles, LA
National Provider Identifier
1154407252
Registry record updated Jun 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5854 Issued in LA
Practice address
2000 Opelousas St
Lake Charles, LA 70601-2641
Phone
(337) 439-9983
Fax
(337) 310-1161
NPI assigned
Oct 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2016

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 5854 LA Primary

Addresses

Primary practice location

2000 Opelousas St
Lake Charles, LA 70601-2641

Mailing address

2000 Opelousas St
Lake Charles, LA 70601-2641
Phone (337) 439-9983

Other identifiers 1

IdentifierTypeStateIssuer
1858544MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160322000054 LA Order and Referring Only - DentistPractitioner - Dentist 9537466495

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465776000000",
    "number": "1154407252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 OPELOUSAS ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706012641",
            "telephone_number": "337-439-9983",
            "fax_number": "337-310-1161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 OPELOUSAS ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706012641",
            "telephone_number": "337-439-9983",
            "fax_number": "337-310-1161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "LAFAITH",
        "middle_name": "CHIVONNE",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-31",
        "last_updated": "2016-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "5854",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1858544",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.