Lakewood Pediatric Dentistry PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

058246 Issued in NY

Legal business name

LAKEWOOD PEDIATRIC DENTISTRY PLLC

Practice address

133 E Fairmount Ave Ste 1
Lakewood, NY 14750-1950

Phone

(716) 763-0130

NPI assigned

Nov 7, 2016

Last updated

Nov 7, 2016By 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. Jan Carlson, DDSNPI 1417059478

Title

Owner/Dentist

Phone

(716) 763-0130

Specialties & licenses 1

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.

• Jan Ray Carlson, DDS

  • Pediatric Dentistry
  • Lakewood, NY
  • NPI 1417059478
  NPD (past) Authorized official

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

{
    "created_epoch": "1478476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478476800000",
    "number": "1417499500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 E FAIRMOUNT AVE STE 1",
            "city": "LAKEWOOD",
            "state": "NY",
            "postal_code": "147501950",
            "telephone_number": "716-763-0130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 E FAIRMOUNT AVE STE 1",
            "city": "LAKEWOOD",
            "state": "NY",
            "postal_code": "147501950",
            "telephone_number": "716-763-0130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD PEDIATRIC DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-07",
        "last_updated": "2016-11-07",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "JAN",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "716-763-0130",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "058246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Kamats, DC
• Rachel E King, PMHNP
• Lake Chutuaqua Dental, PC (Mondovi Dental)
• Lakeside Medical Practice PLLC (Lakeside Medical Practice)
• Lakewood Apothecary and Natural Health Center Inc (Lakewood Apothecary Natural Health Care Inc)
• Verna Lepley, COTA
• Karen Wise Lindeman, PH.D.
• Thomas J Lovecchio, BS PHARMACY
• Leanna Luka, LCSW
• Angela Lunz

• Pediatric Dentistry in Lakewood, NY
• Providers in Lakewood, NY by specialty
• Pediatric Dentistry in New York

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