Mark A Mastellotto, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

17762 Issued in MI

Practice address

760 Riverside Ave
Adrian, MI 49221-1445

Phone

(517) 263-0338

Fax

(517) 263-1138

NPI assigned

Dec 12, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Mark a. Mastellotto

  • Clinic/Center
  • Adrian, MI
  • NPI 1972211134
  NPD Authorized official
• Mark a Mastellotto Ddspc

  • Dental Laboratory
  • Adrian, MI
  • NPI 1588398333
  NPD

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327017600000",
    "number": "1013077601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "760 RIVERSIDE AVE",
            "city": "ADRIAN",
            "state": "MI",
            "postal_code": "492211445",
            "telephone_number": "517-263-0338",
            "fax_number": "517-263-1138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 RIVERSIDE AVE",
            "city": "ADRIAN",
            "state": "MI",
            "postal_code": "492211445",
            "telephone_number": "517-263-0338",
            "fax_number": "517-263-1138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASTELLOTTO",
        "first_name": "MARK",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2012-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "17762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gloria Terese Martell, MSW, LMSW, ACSW, SSW
• Donald J Martin Jr., MD
• Bryana Marie Martinez
• Madison Mae Martinez, BSW
• Darryl J Martins, DPM
• Sunny Rae Masterton, RPH
• Thomas K Mathew, M.D.
• Scott Mathew Mattern
• Danyelle Matthews
• Maverick Spirits LLC

• Dentist in Adrian, MI
• Providers in Adrian, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2012; 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.