Educare Dental Services, Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

464 Issued in NM

Legal business name

EDUCARE DENTAL SERVICES, INC.

Practice address

7 Pineway Blvd
Clovis, NM 88101-8464

Phone

(505) 762-4833

Fax

(505) 762-4833

NPI assigned

Oct 27, 2005

Last updated

Mar 11, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Cynthia Ann Lakin, RDH

Title

Owner

Phone

(505) 762-4833

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268265600000",
    "number": "1669462800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 PINEWAY BLVD",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881018464",
            "telephone_number": "505-762-4833",
            "fax_number": "505-762-4833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 PINEWAY BLVD",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881018464",
            "telephone_number": "505-762-4833",
            "fax_number": "505-762-4833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDUCARE DENTAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-27",
        "last_updated": "2010-03-11",
        "status": "A",
        "authorized_official_last_name": "LAKIN",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-762-4833",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RDH"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER I.D.",
            "identifier": "16900588",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "68528",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Clovis, NM
• Providers in Clovis, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2010; 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.