Active NPI
John Michael Lies, DDS
- Endodontics
- Garden Grove, CA
National Provider Identifier
1952324550
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 39440
- Practice address
- 12777 Valley View St Ste 252
Garden Grove, CA 92845-2522 - Phone
- (714) 799-2888
- Fax
- (714) 799-2788
- NPI assigned
- Jul 25, 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 39440 | CA | Primary |
Addresses
Primary practice location
12777 Valley View St Ste 252
Garden Grove, CA 92845-2522
Mailing address
12777 Valley View St Ste 252
Garden Grove, CA 92845-2522
Phone (714) 799-2888
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 19, 2015 through Mar 19, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39440 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1952324550",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12777 VALLEY VIEW ST STE 252",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928452522",
"telephone_number": "714-799-2888",
"fax_number": "714-799-2788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12777 VALLEY VIEW ST STE 252",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928452522",
"telephone_number": "714-799-2888",
"fax_number": "714-799-2788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIES",
"first_name": "JOHN",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-25",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "39440",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garden Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.