Active NPI
Skylar Alan Lighthall, DDS
- Dentist
- Albuquerque, NM
National Provider Identifier
1245587476
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DD4375
- Practice address
- 9401 Coors Blvd NW
Albuquerque, NM 87114-4007 - Phone
- (505) 890-2773
- Fax
- (505) 898-3022
- NPI assigned
- Aug 7, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DD4375 | NM | Primary |
| General Practice Dentistry | 1223G0001X | 8115 | SC |
Addresses
Primary practice location
9401 Coors Blvd NW
Albuquerque, NM 87114-4007
Mailing address
9401 Coors Blvd NW
Albuquerque, NM 87114-4007
Phone (505) 890-2773
Other practice location 1
10 Medical Park
Dental Dept -
Columbia, SC 29203
Phone (803) 434-6567
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
| License | State | Type | Specialty |
|---|---|---|---|
| 8115 | SC | MD | Professional Counselor |
| DD4375 | NM | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lighthall Family Dentistry of Gilbert PLC | Dentist | Past | Accepting new patients |
| Smiles at Mercy Gilbert LLC | Dentist | 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.
-
- Dentist
- Gilbert, AZ
- NPI 1417350331
-
- Dentist
- Gilbert, AZ
- NPI 1619347044
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613433600000",
"number": "1245587476",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9401 COORS BLVD NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871144007",
"telephone_number": "505-890-2773",
"fax_number": "505-898-3022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9401 COORS BLVD NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871144007",
"telephone_number": "505-890-2773",
"fax_number": "505-898-3022"
}
],
"practiceLocations": [
{
"address_1": "10 Medical Park",
"address_2": "Dental Dept -",
"address_purpose": "LOCATION",
"city": "Columbia",
"state": "SC",
"postal_code": "29203",
"country_code": "US",
"telephone_number": "803-434-6567",
"fax_number": "803-434-6299",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LIGHTHALL",
"first_name": "SKYLAR",
"middle_name": "ALAN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-07",
"last_updated": "2021-02-16",
"certification_date": "2021-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NM",
"license": "DD4375",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "SC",
"license": "8115",
"primary": false
}
],
"identifiers": [],
"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 Feb 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.