Ethan Shamus Lafferty, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

4224 Issued in WV

Practice address

1321 Stadium Dr
Bluefield, WV 24701-3318

Phone

(304) 327-7135

Fax

(304) 327-0758

NPI assigned

Jul 22, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Rainelle Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Maxwelton, WV
  • NPI 1528417946

  WV

  Medicare reassignment NPD
• Ethan Lafferty, DDS, PLLC

  • General Practice Dentistry
  • Bluefield, WV
  • NPI 1104605989
  NPD Authorized official
• Rainelle Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Caldwell, WV
  • NPI 1578399085
  NPD
• Matthew P. McGinnis, DDS, PLLC

  • Dentist
  • Sophia, WV
  • NPI 1508185489
  NPD (past)
• Roger D. Clay, D.D.S.,Inc

  • General Practice Dentistry
  • Sophia, WV
  • NPI 1932284452
  NPD (past)

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

{
    "created_epoch": "1469145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695254400000",
    "number": "1285087494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1321 STADIUM DR",
            "city": "BLUEFIELD",
            "state": "WV",
            "postal_code": "247013318",
            "telephone_number": "304-327-7135",
            "fax_number": "304-327-0758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1321 STADIUM DR",
            "city": "BLUEFIELD",
            "state": "WV",
            "postal_code": "247013318",
            "telephone_number": "304-327-7135",
            "fax_number": "304-327-0758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAFFERTY",
        "first_name": "ETHAN",
        "middle_name": "SHAMUS",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-22",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WV",
            "license": "4224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abed Koja, M.D.
• Radha K Krishnan, MD
• Kroger Limited Partnership I
• Paul R Kuraguntla, MD
• Laboratory Corporation of America Holdings
• Ameneh Lambert, NP
• Latasha N Lambert
• Misty Lambert
• Rebecca Lambert
• Shauntae Lane

• All providers in Bluefield, WV
• Dentist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 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.

Verify at the official NPI Registry.