Individual provider Active NPI

Benjamin Lacy, DMD

  • Dentist
  • Rockport, ME
National Provider Identifier
1255823043
Registry record updated Jun 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DEN4619 Issued in ME
Practice address
1060 Commercial St
Rockport, ME 04856-3801
Phone
(207) 594-5500
Fax
(207) 596-6349
NPI assigned
Jun 6, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DEN4619 ME Primary

Addresses

Primary practice location

1060 Commercial St
Rockport, ME 04856-3801

Mailing address

1060 Commercial St
Rockport, ME 04856-3801
Phone (207) 594-5500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210622002740 ME Order and Referring Only - DentistPractitioner - Dentist 9931500493

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1528243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528243200000",
    "number": "1255823043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1060 COMMERCIAL ST",
            "city": "ROCKPORT",
            "state": "ME",
            "postal_code": "048563801",
            "telephone_number": "207-594-5500",
            "fax_number": "207-596-6349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 COMMERCIAL ST",
            "city": "ROCKPORT",
            "state": "ME",
            "postal_code": "048563801",
            "telephone_number": "207-594-5500",
            "fax_number": "207-596-6349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACY",
        "first_name": "BENJAMIN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-06",
        "last_updated": "2018-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ME",
            "license": "DEN4619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockport, ME

Sources for this page

Verify at the official NPI Registry.