Active NPI
John Anderson, LD
- Denturist
- Lacey, WA
National Provider Identifier
1366560302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Denturist
- License
- 260
- Practice address
- 4408 Pacific Ave SE
Lacey, WA 98503-1119 - Phone
- (360) 438-8299
- Fax
- (360) 438-1399
- NPI assigned
- Mar 27, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Denturist | 122400000X | 260 | WA | Primary |
Addresses
Primary practice location
4408 Pacific Ave SE
Lacey, WA 98503-1119
Mailing address
4408 Pacific Ave SE
Lacey, WA 98503-1119
Phone (360) 438-8299
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 260 | WA | MD | Denturist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Olympic Dental Center, LLC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dental Clinic/Center
- Lacey, WA
- NPI 1780733204
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366560302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4408 PACIFIC AVE SE",
"city": "LACEY",
"state": "WA",
"postal_code": "985031119",
"telephone_number": "360-438-8299",
"fax_number": "360-438-1399"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4408 PACIFIC AVE SE",
"city": "LACEY",
"state": "WA",
"postal_code": "985031119",
"telephone_number": "360-438-8299",
"fax_number": "360-438-1399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "JOHN",
"name_prefix": "Mr.",
"credential": "LD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122400000X",
"taxonomy_group": "",
"desc": "Denturist",
"state": "WA",
"license": "260",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lacey, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.