Individual provider Active NPI

Laura Fitzpatrick Sass Meincke, DDS

  • General Practice Dentistry
  • Wilton, IA
National Provider Identifier
1346624020
Registry record updated Oct 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DDS-09219 Issued in IA
Practice address
325 Cedar St
Wilton, IA 52778-7713
Phone
(563) 732-2612
NPI assigned
Jul 13, 2015
Last updated
Oct 10, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 10, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DDS-09219 IA Primary

Addresses

Primary practice location

325 Cedar St
Wilton, IA 52778-7713

Mailing address

PO Box 399
Wilton, IA 52778-0399
Phone (563) 732-2612

Other practice location 1

125 Scott St
Davenport, IA 52801-1130
Phone (563) 336-3000

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidIA

Other names 1

  • Dr. Laura Fitzpatrick Sass Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20160122001028 IL Order and Referring Only - DentistPractitioner - Dentist 6901109040

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DDS-09219IAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1436745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570665600000",
    "number": "1346624020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 399",
            "city": "WILTON",
            "state": "IA",
            "postal_code": "527780399",
            "telephone_number": "563-732-2612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 CEDAR ST",
            "city": "WILTON",
            "state": "IA",
            "postal_code": "527787713",
            "telephone_number": "563-732-2612"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "125 Scott St",
            "address_purpose": "LOCATION",
            "city": "Davenport",
            "state": "IA",
            "postal_code": "528011130",
            "country_code": "US",
            "telephone_number": "563-336-3000",
            "fax_number": "563-336-3229",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SASS MEINCKE",
        "first_name": "LAURA",
        "middle_name": "FITZPATRICK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-13",
        "last_updated": "2019-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "DDS-09219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "SASS",
            "middle_name": "FITZPATRICK",
            "prefix": "DR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wilton, IA

Sources for this page

Verify at the official NPI Registry.