Active NPI
Etienne Lacrampe, D.M.D.
- Periodontics
- Walnut Creek, CA
National Provider Identifier
1952529661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 58771
- Practice address
- 1844 San Miguel Dr Ste 209
Walnut Creek, CA 94596-4913 - Phone
- (925) 937-6350
- Fax
- (925) 937-6352
- NPI assigned
- Apr 20, 2007
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 58771 | CA | Primary |
Addresses
Primary practice location
1844 San Miguel Dr Ste 209
Walnut Creek, CA 94596-4913
Mailing address
11982 NE Glisan St
Portland, OR 97220-2143
Phone (503) 257-8787
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 Apr 24, 2026 through Apr 24, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58771 | CA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634860800000",
"number": "1952529661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11982 NE GLISAN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972202143",
"telephone_number": "503-257-8787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1844 SAN MIGUEL DR STE 209",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945964913",
"telephone_number": "925-937-6350",
"fax_number": "925-937-6352"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LACRAMPE",
"first_name": "ETIENNE",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-20",
"last_updated": "2021-10-22",
"certification_date": "2021-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "58771",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Walnut Creek, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2021; 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.