Active NPI
Mary Ann Lucero, DDS
- Dentist
- Albuquerque, NM
National Provider Identifier
1174500755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DD1879
- Practice address
- 2201 Louisiana Blvd
Ste D
Albuquerque, NM 87110 - Phone
- (505) 883-4867
- Fax
- (505) 883-4007
- NPI assigned
- Dec 27, 2005
- 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 | DD1879 | NM | Primary |
Addresses
Primary practice location
2201 Louisiana Blvd
Ste D
Albuquerque, NM 87110
Mailing address
2201 Louisiana Blvd NE
Ste D
Albuquerque, NM 87110-4546
Phone (505) 883-4867
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DD1879 | Other | NM | DENTAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160314000531 | NM | Order and Referring Only - Dentist | 7214233519 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD1879 | NM | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370476800000",
"number": "1174500755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2201 LOUISIANA BLVD NE",
"address_2": "STE D",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871104546",
"telephone_number": "505-883-4867",
"fax_number": "505-883-4007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2201 LOUISIANA BLVD",
"address_2": "STE D",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "87110",
"telephone_number": "505-883-4867",
"fax_number": "505-883-4007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUCERO",
"first_name": "MARY ANN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-27",
"last_updated": "2013-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NM",
"license": "DD1879",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE",
"identifier": "DD1879",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2013; 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.