Lucas Todd Whittle, DMD
Individual provider Active NPI Dentist · Jamestown, KY
NPI 1245812684 · NPPES record last updated Jan 23, 2023
Key facts
- NPI
- 1245812684
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 10631 (KY)
- Practice address
- 2620 N Main St
Jamestown, KY 42629-2541 - Phone
- (859) 495-2442
- NPI assigned
- Apr 26, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210804002749 | KY | Order and Referring Only - Dentist |
6103220744 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 10631 | KY | Yes |
| General Practice Dentistry |
1223G0001X | 10631 | KY |
Addresses
Primary practice location
2620 N Main St
Jamestown, KY 42629-2541
Mailing address
576 Water Works Rd
Jamestown, KY 42629-7840
Phone (270) 566-3115
Other practice location 1
3876 South Highway 127
Somerset, KY 42501
Phone (606) 271-1740
Other practice location 2
108 Plaza Dr
Albany, KY 42602-1659
Phone (606) 557-1023
Other providers in Jamestown, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 23, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.