Active NPI
Wanda Puckett, DDS
- General Practice Dentistry
- Lake Charles, LA
National Provider Identifier
1285734640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6108
- Practice address
- 2000 Opelousas Street
Lake Charles, LA 70601 - Phone
- (337) 439-9983
- Fax
- (337) 439-3224
- NPI assigned
- Sep 25, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0366751 | NY | |
| Dentist | 122300000X | 08746 | CT | |
| General Practice Dentistry | 1223G0001X | 6108 | LA | Primary |
Addresses
Primary practice location
2000 Opelousas Street
Lake Charles, LA 70601
Mailing address
2000 Opelousas Street
Lake Charles, LA 70601
Phone (337) 439-9983
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00749308 | Medicaid | NY |
Other names 1
- Dr. Wanda Puckett
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6108 | LA | MD | Professional Counselor |
| 08746 | CT | MD | Dentist |
| 0366751 | NY | MD | Dentist |
| 036675 | NY | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Syracuse Community Health Center, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Federally Qualified Health Center (FQHC)
- Syracuse, NY
- NPI 1497796353
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377043200000",
"number": "1285734640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 OPELOUSAS STREET",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "70601",
"telephone_number": "337-439-9983",
"fax_number": "337-439-3224"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 OPELOUSAS STREET",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "70601",
"telephone_number": "337-439-9983",
"fax_number": "337-439-3224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCKETT",
"first_name": "WANDA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-25",
"last_updated": "2013-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "0366751",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CT",
"license": "08746",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "LA",
"license": "6108",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00749308",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "WANDA",
"last_name": "PUCKETT",
"prefix": "DR.",
"credential": "DDS",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Lake Charles, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.