Active NPI
Mackenson Montas
- Student in an Organized Health Care Education/Training Program
- Washington, DC
National Provider Identifier
1023638491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 2041 Georgia Ave NW
Washington, DC 20060-0002 - Phone
- (516) 754-1168
- NPI assigned
- Apr 25, 2020
- 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 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22DI02801400 | NJ | |
| Dentist | 122300000X | DN1859008 | MA | |
| General Practice Dentistry | 1223G0001X | 22DI02801400 | NJ | |
| General Practice Dentistry | 1223G0001X | DN1859008 | MA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | DC | Primary |
Addresses
Primary practice location
2041 Georgia Ave NW
Washington, DC 20060-0002
Mailing address
2041 Georgia Ave NW
Washington, DC 20060-0002
Phone (516) 754-1168
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 |
|---|---|---|---|
| DN1859008 | MA | MD | Dentist |
| 22DI02801400 | NJ | MD | General Practice Dentistry |
Interoperability endpoints
- mmontas1206819@valleyhealth.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681862400000",
"number": "1023638491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2041 GEORGIA AVE NW",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200600002",
"telephone_number": "516-754-1168"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2041 GEORGIA AVE NW",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200600002",
"telephone_number": "516-754-1168"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONTAS",
"first_name": "MACKENSON",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-04-25",
"last_updated": "2023-04-19",
"certification_date": "2023-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "22DI02801400",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DN1859008",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NJ",
"license": "22DI02801400",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "DN1859008",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "DC",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.