Active NPI
Matthew W Lackney, DMD
- Dentist
- Deerfield, IL
National Provider Identifier
1558509653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 30.019889
- Practice address
- 775 Waukegan Rd
Suite 200
Deerfield, IL 60015-4342 - Phone
- (847) 267-9440
- Fax
- (800) 434-7113
- NPI assigned
- Jan 27, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30.019889 | OH | Primary |
Addresses
Primary practice location
775 Waukegan Rd
Suite 200
Deerfield, IL 60015-4342
Mailing address
775 Waukegan Rd
Suite 200
Deerfield, IL 60015-4342
Phone (847) 267-9440
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30.019889 | OH | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Matthew W Lackney DMD Inc | Dentist | Past | Accepting new patients |
| Primesource Healthcare Systems, Inc. | Dentist | Past | Accepting new patients |
| Primesource Healthcare Systems, Inc. | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233014400000",
"number": "1558509653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "775 WAUKEGAN RD",
"address_2": "SUITE 200",
"city": "DEERFIELD",
"state": "IL",
"postal_code": "600154342",
"telephone_number": "847-267-9440",
"fax_number": "800-434-7113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "775 WAUKEGAN RD",
"address_2": "SUITE 200",
"city": "DEERFIELD",
"state": "IL",
"postal_code": "600154342",
"telephone_number": "847-267-9440",
"fax_number": "800-434-7113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LACKNEY",
"first_name": "MATTHEW",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-27",
"last_updated": "2009-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "30.019889",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Deerfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.