Individual provider Active NPI

Silas PO Kwong Lai, D.D.S.

  • Dentist
  • Fort Worth, TX
National Provider Identifier
1629458641
Registry record updated Nov 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
30897 Issued in TX
Practice address
4701 Bryant Irvin Rd N
Fort Worth, TX 76107-7627
Phone
(817) 702-1100
Fax
(817) 569-9069
NPI assigned
Jun 4, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 30897 TX Primary

Addresses

Primary practice location

4701 Bryant Irvin Rd N
Fort Worth, TX 76107-7627

Mailing address

PO Box 732973
Dallas, TX 75373-2973
Phone (817) 702-8450

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20190110003036 TX Practitioner - Dentist 5698046514 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30897TXMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Acclaim Physician Group, Inc CurrentSince Jan 14, 2019 Accepting new patients
Lawton Indian Hospital Past Accepting new patients

Locations

1350 S Main St
Fl 1
Fort Worth, TX 76104
Phone (817) 702-3701

4701 Bryant Irvin Rd N
Ft Worth, TX 76107
Phone (817) 702-7400

1412 May St
Ft Worth, TX 76104
Phone (817) 625-8818

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541721600000",
    "number": "1629458641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 732973",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753732973",
            "telephone_number": "817-702-8450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 BRYANT IRVIN RD N",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761077627",
            "telephone_number": "817-702-1100",
            "fax_number": "817-569-9069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAI",
        "first_name": "SILAS",
        "middle_name": "PO KWONG",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-04",
        "last_updated": "2018-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "30897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.