Liliana Caicedo, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

55201 Issued in CA

Practice address

925 Bevins CT
Lakeport, CA 95453-9754

Phone

(707) 263-8382

NPI assigned

Oct 7, 2011

Last updated

Aug 1, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Lake County Tribal Health Consortium Inc.

  • Federally Qualified Health Center (FQHC)
  • Lakeport, CA
  • NPI 1881697381
  Medicare reassignment NPD
• Lake County Tribal Health Southshore Clinic

  • Federally Qualified Health Center (FQHC)
  • Clearlake, CA
  • NPI 1063158038
  NPD

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

{
    "created_epoch": "1317945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754006400000",
    "number": "1508140591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1950",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954531950",
            "telephone_number": "707-263-8383",
            "fax_number": "707-263-5019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 BEVINS CT",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954539754",
            "telephone_number": "707-263-8382"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14440 Olympic Drive",
            "address_purpose": "LOCATION",
            "city": "Clearlake",
            "state": "CA",
            "postal_code": "954228809",
            "country_code": "US",
            "telephone_number": "707-263-8383",
            "fax_number": "707-263-5019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAICEDO",
        "first_name": "LILIANA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-07",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "55201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Louise Bradley, P. T.
• Stephen Peter Bradley, MD
• David L. Browning, O.D.
• Mark Louis Buehnerkemper, O.D.
• Carleene Janice Cady, NP
• California Pacific Pathology Medical Group
• Lawerence G Cannon, DDS
• Donna Carr, PHARMD
• Jovany Carrillo
• Jealena C Casperson

• Dentist in Lakeport, CA
• Providers in Lakeport, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.