Camai Dental Clinic LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

673 Issued in AK

Legal business name

CAMAI DENTAL CLINIC LLC

Doing business as

Dental Innovations

Practice address

3161 E Palmer Wasilla Hwy
Ste 5
Wasilla, AK 99654-7271

Phone

(907) 357-5214

Fax

(907) 357-5213

NPI assigned

Jan 17, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Kelly Wade Lucas, DDS

Title

Owner/Practitioner

Phone

(907) 357-5214

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dental Innovations Doing business as

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

{
    "created_epoch": "1484611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484611200000",
    "number": "1376089128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3161 E PALMER WASILLA HWY",
            "address_2": "STE 5",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547271",
            "telephone_number": "907-357-5214",
            "fax_number": "907-357-5213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3161 E PALMER WASILLA HWY",
            "address_2": "STE 5",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547271",
            "telephone_number": "907-357-5214",
            "fax_number": "907-357-5213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMAI DENTAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-17",
        "last_updated": "2017-01-17",
        "status": "A",
        "authorized_official_last_name": "LUCAS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "WADE",
        "authorized_official_title_or_position": "OWNER/PRACTITIONER",
        "authorized_official_telephone_number": "907-357-5214",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AK",
            "license": "673",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003119",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Innovations",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Wasilla, AK
• Providers in Wasilla, AK by specialty
• General Practice Dentistry in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2017; 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.