Active NPI
John S Miceli, DMD
- Orthodontics and Dentofacial Orthopedics Dentistry
- Wilmington, MA
National Provider Identifier
1003909953
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 11925
- Practice address
- 306 Main St
Wilmington, MA 01887-2725 - Phone
- (978) 491-8847
- NPI assigned
- Oct 2, 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 11925 | MA | Primary |
Addresses
Primary practice location
306 Main St
Wilmington, MA 01887-2725
Mailing address
PO Box 7116
Gloucester, MA 01930-5816
Phone (978) 491-8847
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0202282 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11925 | MA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441324800000",
"number": "1003909953",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7116",
"city": "GLOUCESTER",
"state": "MA",
"postal_code": "019305816",
"telephone_number": "978-491-8847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "306 MAIN ST",
"city": "WILMINGTON",
"state": "MA",
"postal_code": "018872725",
"telephone_number": "978-491-8847"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICELI",
"first_name": "JOHN",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2015-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "MA",
"license": "11925",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0202282",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.