Active NPI
Enrique Lacuesta, D.D.S.
- Periodontics
- Gulfport, MS
National Provider Identifier
1871656686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 1758-77
- Practice address
- 22-29TH Street
Suite a
Gulfport, MS 39507 - Phone
- (228) 868-9615
- Fax
- (228) 868-9677
- NPI assigned
- Dec 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 1758-77 | MS | Primary |
Addresses
Primary practice location
22-29TH Street
Suite a
Gulfport, MS 39507
Mailing address
22-29TH Street
Suite a
Gulfport, MS 39507
Phone (228) 868-9615
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 755128 | Other | MS | UNITED CONCORDIA PROVIDER |
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 |
|---|---|---|---|
| 1758-77 | MS | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1871656686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22-29TH STREET",
"address_2": "SUITE A",
"city": "GULFPORT",
"state": "MS",
"postal_code": "39507",
"telephone_number": "228-868-9615",
"fax_number": "228-868-9677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22-29TH STREET",
"address_2": "SUITE A",
"city": "GULFPORT",
"state": "MS",
"postal_code": "39507",
"telephone_number": "228-868-9615",
"fax_number": "228-868-9677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LACUESTA",
"first_name": "ENRIQUE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MS",
"license": "1758-77",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA PROVIDER",
"identifier": "755128",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gulfport, MS
Sources for this page
- 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.