Lagina Dawn Bickham, DMD
Individual provider Active NPI General Practice Dentistry · Roxbury, MA
NPI 1508943382 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1508943382
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D18179 (MA)
- Practice address
- 55 Dimock St
Roxbury, MA 02119-1029 - Phone
- (617) 442-8800
- Fax
- (617) 541-0950
- NPI assigned
- Nov 1, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in RI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171206001715 | RI | Order and Referring Only - Dentist |
1850670076 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D18179 | MA | MD | General Practice Dentistry |
| 18179 | MA | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D18179 | MA | Yes |
Addresses
Primary practice location
55 Dimock St
Roxbury, MA 02119-1029
Mailing address
17 Dryden Ave
Pawtucket, RI 02860-5720
Phone (401) 487-1285
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1301144 | Medicaid | MA |
Other providers in Roxbury, MA
- Markarius Bentley
- Douglas Benton
- Anna Berestova
- Berthlyn M Bernier
- Hermine Berry
- Zachary Biedermann
- Maria Pia Biggs
- Hala Hussain Binshayhon
- Bio-Medical Applications of Massachusetts, Inc.
- Andrea Rose Biondi
All providers in Roxbury, MA · General Practice Dentistry in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.