Brian David Lackey, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

40457 Issued in CA

Practice address

675 Pine Ave
Pacific Grove, CA 93950-3373

Phone

(831) 649-1055

NPI assigned

Jan 25, 2007

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Carrazana, DDS, Apdc

  dba Moonflower Dentistry

  • General Practice Dentistry
  • Pacific Grove, CA
  • NPI 1912631474
  NPD (past)

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649326703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 PINE AVE",
            "city": "PACIFIC GROVE",
            "state": "CA",
            "postal_code": "939503373",
            "telephone_number": "831-649-1055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 PINE AVE",
            "city": "PACIFIC GROVE",
            "state": "CA",
            "postal_code": "939503373",
            "telephone_number": "831-649-1055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACKEY",
        "first_name": "BRIAN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "40457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maggie King
• Jamie L Klinefelter, DMD
• Sylvia Krimsley, M.F.T.
• Molly Kriva, CCC-SLP
• Arlen Dale Lackey, D.D.S.
• Adriana Lalinde, DDS
• Frances Lansdowne, MS
• Suzanne M Le Bon, RD, CNSC, CLC
• Soojeong Lee, LA.C
• Janelle Brooke Lemons, DPT

• General Practice Dentistry in Pacific Grove, CA
• Providers in Pacific Grove, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.