Individual provider Active NPI

Betzy A Lara Perdue, DDS

  • Dentist
  • The Woodlands, TX
National Provider Identifier
1942235239
Registry record updated May 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
20272 Issued in TX
Practice address
3091 College Park Dr
#125
The Woodlands, TX 77384
Phone
(936) 271-3338
Fax
(936) 271-3320
NPI assigned
Jul 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 20272 TX Primary

Addresses

Primary practice location

3091 College Park Dr
#125
The Woodlands, TX 77384

Mailing address

3091 College Park Dr
#125
The Woodlands, TX 77384
Phone (936) 271-3338

Other identifiers 1

IdentifierTypeStateIssuer
147983402MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160226002092 TX Order and Referring Only - DentistPractitioner - Dentist 7315242484

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
North Forest Family Dental Care Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430956800000",
    "number": "1942235239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3091 COLLEGE PARK DR",
            "address_2": "#125",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "77384",
            "telephone_number": "936-271-3338",
            "fax_number": "936-271-3320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3091 COLLEGE PARK DR",
            "address_2": "#125",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "77384",
            "telephone_number": "936-271-3338",
            "fax_number": "936-271-3320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARA PERDUE",
        "first_name": "BETZY",
        "middle_name": "A",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2015-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "20272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "147983402",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in The Woodlands, TX

Sources for this page

Verify at the official NPI Registry.