Active NPI
Lydia Claire Wyatt, DDS
- General Practice Dentistry
- Las Vegas, NV
National Provider Identifier
1942377304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4340
- Practice address
- 1140 N Town Center Dr
Suite 170
Las Vegas, NV 89144-6379 - Phone
- (702) 220-9555
- NPI assigned
- Nov 29, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4340 | NV | Primary |
Addresses
Primary practice location
1140 N Town Center Dr
Suite 170
Las Vegas, NV 89144-6379
Mailing address
72 Panorama Crest Ave
Las Vegas, NV 89135-7831
Phone (702) 220-9555
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- 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 |
|---|---|---|---|---|
| I20160329001666 | NV | Order and Referring Only - Dentist | 0840597365 |
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": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257379200000",
"number": "1942377304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "72 PANORAMA CREST AVE",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891357831",
"telephone_number": "702-220-9555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1140 N TOWN CENTER DR",
"address_2": "SUITE 170",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891446379",
"telephone_number": "702-220-9555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYATT",
"first_name": "LYDIA",
"middle_name": "CLAIRE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-29",
"last_updated": "2009-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NV",
"license": "4340",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2009; 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.