NPIMap

Organization Active NPI

Lockport Dental Group, P.C.

  • General Practice Dentistry
  • Lockport, NY
National Provider Identifier
1154482818
Registry record updated Jul 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LOCKPORT DENTAL GROUP, P.C.
Doing business as
LDG Sleep Academy
Practice address
39 Elizabeth Dr
Lockport, NY 14094-5226
Phone
(716) 433-6004
Fax
(716) 433-7547
NPI assigned
Dec 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2015

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

Authorized official

Name
Dr. Todd Mitchell Retell, DDSNPI 1720163884
Title
President
Phone
(716) 433-6004

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary
Customized Equipment (DME) 332BC3200X 041617 NY

Addresses

Primary practice location

39 Elizabeth Dr
Lockport, NY 14094-5226

Mailing address

39 Elizabeth Dr
Lockport, NY 14094-5226
Phone (716) 433-6004

Other names 1

  • LDG Sleep Academy Doing business as

National Provider Directory

National Provider Directory

Locations

39 Elizabeth Dr
Lockport, NY 14094
Phone (716) 433-6004

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436227200000",
    "number": "1154482818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 ELIZABETH DR",
            "city": "LOCKPORT",
            "state": "NY",
            "postal_code": "140945226",
            "telephone_number": "716-433-6004",
            "fax_number": "716-433-7547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 ELIZABETH DR",
            "city": "LOCKPORT",
            "state": "NY",
            "postal_code": "140945226",
            "telephone_number": "716-433-6004",
            "fax_number": "716-433-7547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOCKPORT DENTAL GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2015-07-07",
        "status": "A",
        "authorized_official_last_name": "RETELL",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "MITCHELL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "716-433-6004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NY",
            "license": "041617",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LDG Sleep Academy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lockport, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2015; 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.