NPIMap

Organization Active NPI

Professional Dental Care of Southern NM I PLLC

  • General Practice Dentistry
  • Portales, NM
National Provider Identifier
1306415955
Registry record updated Jun 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PROFESSIONAL DENTAL CARE OF SOUTHERN NM I PLLC
Practice address
123 W 2ND St
Portales, NM 88130-6201
Phone
(575) 448-8863
NPI assigned
Jun 18, 2021
Organization subpart
Yes
Parent organization
PROFESSIONAL DENTAL CARE PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 18, 2021

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

Authorized official

Name
Cary Lacouture, DDS
Title
Clinical Director
Phone
(303) 521-5701

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

123 W 2ND St
Portales, NM 88130-6201

Mailing address

123 W 2ND St
Portales, NM 88130-6201
Phone (575) 448-8863

Other names 1

  • Peter Thompson, DDS Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Peter Thompson DDS2 organizations share this tax ID, including this one
Part of
Professional Dental Care PLLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

123 W 2nd St
Portales, NM 88130
Phone (505) 359-1011

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1623974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623974400000",
    "number": "1306415955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 W 2ND ST",
            "city": "PORTALES",
            "state": "NM",
            "postal_code": "881306201",
            "telephone_number": "575-448-8863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 W 2ND ST",
            "city": "PORTALES",
            "state": "NM",
            "postal_code": "881306201",
            "telephone_number": "575-448-8863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL CARE OF SOUTHERN NM I PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROFESSIONAL DENTAL CARE PLLC",
        "enumeration_date": "2021-06-18",
        "last_updated": "2021-06-18",
        "certification_date": "2021-06-18",
        "status": "A",
        "authorized_official_last_name": "LACOUTURE",
        "authorized_official_first_name": "CARY",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "303-521-5701",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peter Thompson, DDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portales, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.