Organization Active NPI

Edward J Lacy Jr DDS PC

Doing business as None

  • Dentist
  • Loveland, CO
National Provider Identifier
1790988830
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5899 Issued in CO
Legal business name
EDWARD J LACY JR DDS PC
Doing business as
None
Practice address
2550 Abarr Dr
Loveland, CO 80538-3156
Phone
(970) 667-2372
NPI assigned
Jun 6, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Edward J Lacy Jr., DDS
Title
Dentist President
Phone
(970) 667-2372

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 5899 CO Primary

Addresses

Primary practice location

2550 Abarr Dr
Loveland, CO 80538-3156

Mailing address

2550 Abarr Dr
Loveland, CO 80538-3156
Phone (970) 667-2372

Other identifiers 1

IdentifierTypeStateIssuer
04013942MedicaidCO

Other names 1

  • None Doing business as

National Provider Directory

National Provider Directory

Locations

2550 Abarr Dr
Loveland, CO 80538
Phone (970) 667-2372

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790988830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 ABARR DR",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805383156",
            "telephone_number": "970-667-2372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 ABARR DR",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805383156",
            "telephone_number": "970-667-2372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD J LACY JR DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LACY",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DENTIST PRESIDENT",
        "authorized_official_telephone_number": "970-667-2372",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "5899",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04013942",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "None",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Loveland, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.