Lake City Dental Specialties, PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D4420PE Issued in ID

Legal business name

LAKE CITY DENTAL SPECIALTIES, PC

Practice address

1322 W Kathleen Ave Ste 2
Coeur D Alene, ID 83815-7365

Phone

(208) 664-7300

Fax

(208) 664-7333

NPI assigned

Oct 7, 2012

Last updated

Oct 7, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Shaun Michael Whitney, DDSNPI 1275848582

Title

President

Phone

(208) 664-7300

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shaun Michael Whitney, D.D.S.

  • Periodontics
  • Coeur d'Alene, ID
  • NPI 1275848582

  Endodontics

  NPD (past) Authorized official

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

{
    "created_epoch": "1349568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349568000000",
    "number": "1356693915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1322 W KATHLEEN AVE STE 2",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838157365",
            "telephone_number": "208-664-7300",
            "fax_number": "208-664-7333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1322 W KATHLEEN AVE STE 2",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838157365",
            "telephone_number": "208-664-7300",
            "fax_number": "208-664-7333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CITY DENTAL SPECIALTIES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-07",
        "last_updated": "2012-10-07",
        "status": "A",
        "authorized_official_last_name": "WHITNEY",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-664-7300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "ID",
            "license": "D4420EN",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "ID",
            "license": "D4420PE",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Martin Ladwig, NP-C
• Jennifer Lageschulte, LMSW-33329
• Lake Bound Physical Therapy PLLC
• Lake City Center, Inc.
• Lake City Dental
• Lake City Medical Investors, LLC (Life Care Center of Coeur D'Alene)
• Lake City Physical Therapy P a
• Lake City Shoe Repair
• Lake City Surgeons PLLC
• Lakeside Eyecare

• Periodontics in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Periodontics in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2012; 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.