NPIMap

Organization Active NPI

Post Office Lake Dental Associates

  • General Practice Dentistry
  • Waldorf, MD
National Provider Identifier
1962663203
Registry record updated Jun 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
10857 Issued in MD
Legal business name
POST OFFICE LAKE DENTAL ASSOCIATES
Practice address
603 Post Office Rd Ste 208
Waldorf, MD 20602-1914
Phone
(301) 870-7077
Fax
(301) 843-8030
NPI assigned
Jun 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2008

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

Authorized official

Name
Mrs. Kameasa Lavonne Johnson
Title
Office Contact
Phone
(301) 870-7077

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 10857 MD Primary

Addresses

Primary practice location

603 Post Office Rd Ste 208
Waldorf, MD 20602-1914

Mailing address

603 Post Office Rd Ste 208
Waldorf, MD 20602-1914
Phone (301) 870-7077

Other identifiers 3

IdentifierTypeStateIssuer
4133552 00MedicaidMD
776024860MedicaidMD
775954160MedicaidMD

National Provider Directory

National Provider Directory

Locations

603 Post Office Rd
Ste 208
Waldorf, MD 20602
Phone (301) 870-6046

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1213833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1962663203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 POST OFFICE RD STE 208",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206021914",
            "telephone_number": "301-870-7077",
            "fax_number": "301-843-8030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 POST OFFICE RD STE 208",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206021914",
            "telephone_number": "301-870-7077",
            "fax_number": "301-843-8030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POST OFFICE LAKE DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-19",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KAMEASA",
        "authorized_official_middle_name": "LAVONNE",
        "authorized_official_title_or_position": "OFFICE CONTACT",
        "authorized_official_telephone_number": "301-870-7077",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "10857",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4133552 00",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "776024860",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "775954160",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; 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.