NPIMap

Organization Active NPI

Lake Havasu Dentistry

  • General Practice Dentistry
  • Lake Havasu City, AZ
National Provider Identifier
1396198263
Registry record updated Jul 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LAKE HAVASU DENTISTRY
Practice address
1971 McCulloch Blvd N
#100
Lake Havasu City, AZ 86403-6117
Phone
(928) 733-6070
Fax
(928) 733-6075
NPI assigned
Jul 15, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2016

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

Authorized official

Name
Laura Vaughn
Title
Manager
Phone
(928) 733-6070

Specialties & licenses 1

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

Addresses

Primary practice location

1971 McCulloch Blvd N
#100
Lake Havasu City, AZ 86403-6117

Mailing address

1971 McCulloch Blvd N
#100
Lake Havasu City, AZ 86403-6117

Other names 1

  • Havasu Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

1971 McCulloch Blvd N
Ste 100
Lake Havasu City, AZ 86403
Phone (928) 733-6070

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1468540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468540800000",
    "number": "1396198263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1971 MCCULLOCH BLVD N",
            "address_2": "#100",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1971 MCCULLOCH BLVD N",
            "address_2": "#100",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036117",
            "telephone_number": "928-733-6070",
            "fax_number": "928-733-6075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE HAVASU DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-15",
        "last_updated": "2016-07-15",
        "status": "A",
        "authorized_official_last_name": "VAUGHN",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "928-733-6070"
    },
    "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": "Havasu Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Havasu City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2016; 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.