Active NPI
Lucas Van Wie, DDS
- Dentist
- Grand Junction, CO
National Provider Identifier
1861126070
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 00205244
- Practice address
- 2773 B 1/2 Rd
Grand Junction, CO 81503-3036 - Phone
- (970) 257-1103
- Fax
- (970) 257-7522
- NPI assigned
- Jul 13, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 00205244 | CO | |
| Dentist | 122300000X | 00205244 | CO | Primary |
Addresses
Primary practice location
2773 B 1/2 Rd
Grand Junction, CO 81503-3036
Mailing address
50 Kuester LK
Grand Island, NE 68801-8609
Phone (308) 390-5067
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00205244 | CO | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1657670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657670400000",
"number": "1861126070",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 KUESTER LK",
"city": "GRAND ISLAND",
"state": "NE",
"postal_code": "688018609",
"telephone_number": "308-390-5067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2773 B 1/2 RD",
"city": "GRAND JUNCTION",
"state": "CO",
"postal_code": "815033036",
"telephone_number": "970-257-1103",
"fax_number": "970-257-7522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN WIE",
"first_name": "LUCAS",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-07-13",
"last_updated": "2022-07-13",
"certification_date": "2022-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CO",
"license": "00205244",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "00205244",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Junction, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.