Active NPI
Lon Patrick Spain, DDS
- Dentist
- Cedar Grove, WV
National Provider Identifier
1891765822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 3400
- Practice address
- 408 Alexander Street
Cedar Grove, WV 25039 - Phone
- (304) 595-1770
- NPI assigned
- Jan 24, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3400 | WV | Primary |
Addresses
Primary practice location
408 Alexander Street
Cedar Grove, WV 25039
Mailing address
PO Box 1680
Huntington, WV 25717-1680
Phone (304) 525-3334
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100174300 | Medicaid | KY | |
| 2036862 | Medicaid | OH | |
| 7805006000 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
- 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 |
|---|---|---|---|---|
| I20150723009021 | WV | Order and Referring Only - Oral Surgery | 1153634811 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1379376000000",
"number": "1891765822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1680",
"city": "HUNTINGTON",
"state": "WV",
"postal_code": "257171680",
"telephone_number": "304-525-3334",
"fax_number": "304-697-2086"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "408 ALEXANDER STREET",
"city": "CEDAR GROVE",
"state": "WV",
"postal_code": "25039",
"telephone_number": "304-595-1770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPAIN",
"first_name": "LON",
"middle_name": "PATRICK",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-24",
"last_updated": "2013-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WV",
"license": "3400",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100174300",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2036862",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7805006000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cedar Grove, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2013; 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.