Active NPI
Lee Johanna Edwards, DDS
- Dentist
- Lacey, WA
National Provider Identifier
1831477520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE60234008
- Practice address
- 1450 Northwest LN SE
Suite C
Lacey, WA 98503-6908 - Phone
- (360) 491-4343
- NPI assigned
- Jul 28, 2011
- Sex
- Female
- Sole proprietor
- No
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 | DE60234008 | WA | Primary |
Addresses
Primary practice location
1450 Northwest LN SE
Suite C
Lacey, WA 98503-6908
Mailing address
1450 Northwest LN SE
Suite C
Lacey, WA 98503-6908
Phone (360) 491-4343
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160609002569 | WA | Order and Referring Only - Oral Surgery | 1153611728 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE60234008 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330560000000",
"number": "1831477520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1450 NORTHWEST LN SE",
"address_2": "SUITE C",
"city": "LACEY",
"state": "WA",
"postal_code": "985036908",
"telephone_number": "360-491-4343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1450 NORTHWEST LN SE",
"address_2": "SUITE C",
"city": "LACEY",
"state": "WA",
"postal_code": "985036908",
"telephone_number": "360-491-4343"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "LEE",
"middle_name": "JOHANNA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-07-28",
"last_updated": "2012-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE60234008",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lacey, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.