Dhda Providerco, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DHDA PROVIDERCO, PLLC

Doing business as

Lavelle Family & Cosmetic Dentistry

Practice address

13104 W Highway 42
Prospect, KY 40059-9102

Phone

(502) 228-0234

NPI assigned

Mar 16, 2020

Last updated

Mar 16, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

DHDA PROVIDERCO, PLLCAs reported in NPPES

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

Authorized official

Name

Paul T Lavelle, DMDNPI 1942304647

Title

Sole Member

Phone

(502) 228-0404

Specialties & licenses 1

Addresses

Other names 1

• Lavelle Family & Cosmetic Dentistry Doing business as

Part of

Dhda Providerco PLLC

Locations

Practitioners 1

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.

• Paul Thomas Lavelle, DMD

  • General Practice Dentistry
  • Prospect, KY
  • NPI 1942304647
  NPD Authorized official

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

{
    "created_epoch": "1584316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584316800000",
    "number": "1902432537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13104 W HIGHWAY 42",
            "city": "PROSPECT",
            "state": "KY",
            "postal_code": "400599102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13104 W HIGHWAY 42",
            "city": "PROSPECT",
            "state": "KY",
            "postal_code": "400599102",
            "telephone_number": "502-228-0234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DHDA PROVIDERCO, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DHDA PROVIDERCO, PLLC",
        "enumeration_date": "2020-03-16",
        "last_updated": "2020-03-16",
        "certification_date": "2020-03-16",
        "status": "A",
        "authorized_official_last_name": "LAVELLE",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "502-228-0404",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lavelle Family & Cosmetic Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jill Marie Didyk, D.M.D.
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• General Practice Dentistry in Prospect, KY
• Providers in Prospect, KY by specialty
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 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.