Individual provider Active NPI

Michael L Santucci, D.D.S.

  • General Practice Dentistry
  • Iowa City, IA
National Provider Identifier
1003031477
Registry record updated Jul 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DDS-09357 Issued in IA
Practice address
322 Dental Science BLDG S
Iowa City, IA 52242-1001
Phone
(319) 335-7440
Fax
(319) 333-7451
NPI assigned
Apr 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DDS-09357 IA Primary
General Practice Dentistry 1223G0001X 1914975 IL

Addresses

Primary practice location

322 Dental Science BLDG S
Iowa City, IA 52242-1001

Mailing address

322 Dental Science BLDG S
Iowa City, IA 52242-1001
Phone (319) 335-7440

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20200729003385 IA Practitioner - Oral Surgery 3870813082 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DDS-09357IAMDGeneral Practice Dentistry
1914975ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
State University of Iowa CurrentSince Jul 1, 2020 Accepting new patients
State University of Iowa CurrentSince Jul 1, 2020 Accepting new patients
Perry K. Tuneberg D.D.S. and Associates General Practice Past Accepting new patients

Locations

322 Dental Science S
Iowa City, IA 52242
Phone (319) 335-7342

200 Hawkins Dr
Iowa City, IA 52242
Phone (319) 356-1616

322 Dental Science S
Bldg S
Iowa City, IA 52242
Phone (319) 384-1139

Organizations & group practices 3

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": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594598400000",
    "number": "1003031477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 DENTAL SCIENCE BLDG S",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421001",
            "telephone_number": "319-335-7440",
            "fax_number": "319-333-7451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 DENTAL SCIENCE BLDG S",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421001",
            "telephone_number": "319-335-7440",
            "fax_number": "319-333-7451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTUCCI",
        "first_name": "MICHAEL",
        "middle_name": "L",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-13",
        "last_updated": "2020-07-13",
        "certification_date": "2020-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "DDS-09357",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "1914975",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Iowa City, IA

Sources for this page

Verify at the official NPI Registry.