Active NPI
Mark Thomas Damerau, DMD
- Dentist
- Palm Beach Gardens, FL
National Provider Identifier
1053433201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 11954
- Practice address
- 400 Village Square Crossing
Palm Beach Gardens, FL 33410-3220 - Phone
- (561) 622-8988
- Fax
- (561) 627-0778
- NPI assigned
- Apr 6, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 11954 | FL | Primary |
Addresses
Primary practice location
400 Village Square Crossing
Palm Beach Gardens, FL 33410-3220
Mailing address
400 Village Square Crossing
Palm Beach Gardens, FL 33410-3220
Phone (561) 622-8988
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 |
|---|---|---|---|
| 11954 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053433201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 VILLAGE SQUARE CROSSING",
"city": "PALM BEACH GARDENS",
"state": "FL",
"postal_code": "334103220",
"telephone_number": "561-622-8988",
"fax_number": "561-627-0778"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 VILLAGE SQUARE CROSSING",
"city": "PALM BEACH GARDENS",
"state": "FL",
"postal_code": "334103220",
"telephone_number": "561-622-8988",
"fax_number": "561-627-0778"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAMERAU",
"first_name": "MARK",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "11954",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palm Beach Gardens, FL
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.