Active NPI
Lucas Todd Whittle, DMD
- Dentist
- Jamestown, KY
National Provider Identifier
1245812684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10631
- Practice address
- 2620 N Main St
Jamestown, KY 42629-2541 - Phone
- (859) 495-2442
- NPI assigned
- Apr 26, 2021
- Last updated
- Jan 23, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 | 10631 | KY | Primary |
| 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
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- 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 |
|---|---|---|---|---|
| I20210804002749 | KY | Order and Referring Only - Dentist | 6103220744 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10631 | KY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674432000000",
"number": "1245812684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "576 WATER WORKS RD",
"city": "JAMESTOWN",
"state": "KY",
"postal_code": "426297840",
"telephone_number": "270-566-3115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2620 N MAIN ST",
"city": "JAMESTOWN",
"state": "KY",
"postal_code": "426292541",
"telephone_number": "859-495-2442"
}
],
"practiceLocations": [
{
"address_1": "3876 South Highway 127",
"address_purpose": "LOCATION",
"city": "Somerset",
"state": "KY",
"postal_code": "42501",
"country_code": "US",
"telephone_number": "606-271-1740",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "108 Plaza Dr",
"address_purpose": "LOCATION",
"city": "Albany",
"state": "KY",
"postal_code": "426021659",
"country_code": "US",
"telephone_number": "606-557-1023",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WHITTLE",
"first_name": "LUCAS",
"middle_name": "TODD",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-04-26",
"last_updated": "2023-01-23",
"certification_date": "2023-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "10631",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "KY",
"license": "10631",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jamestown, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2023; 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.