Alphonso L. Mack, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

005845 Issued in CT

Practice address

2 Wintonbury Mall
Building #5
Bloomfield, CT 06002-2466

Phone

(860) 243-5451

Fax

(860) 656-6107

NPI assigned

Jul 17, 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

Practice roles

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.

• Wintonbury Dental Associates, P.C.

  • General Practice Dentistry
  • Bloomfield, CT
  • NPI 1982837845

  General Practice

  NPD (past) Authorized official

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043237704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 WINTONBURY MALL",
            "address_2": "BUILDING #5",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060022466",
            "telephone_number": "860-243-5451",
            "fax_number": "860-656-6107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 WINTONBURY MALL",
            "address_2": "BUILDING #5",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060022466",
            "telephone_number": "860-243-5451",
            "fax_number": "860-656-6107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "ALPHONSO",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "005845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002058451 00",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eugenia Ettlin Loverde, MD
• Nelly Lugo-Larcheveque, PT
• Maury Luxemburg, MD
• Lynda Dunlop Aprn
• Krystal L Macca
• Linda Mackay-Morgan
• Lynn Mahoney, LMFT
• Leslie Mandelbaum
• Marc Jeffrey Mann, PHD
• Katherine Mara

• General Practice Dentistry in Bloomfield, CT
• Providers in Bloomfield, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.