Individual provider Active NPI

William D Mestichelli, DDS

  • General Practice Dentistry
  • Philadelphia, PA
National Provider Identifier
1063543015
Registry record updated May 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS022834L Issued in PA
Practice address
1727 S Broad St
Philadelphia, PA 19148-1527
Phone
(215) 334-2000
Fax
(215) 755-7333
NPI assigned
Mar 8, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 22, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DS022834L PA Primary

Addresses

Primary practice location

1727 S Broad St
Philadelphia, PA 19148-1527

Mailing address

1727 S Broad St
Philadelphia, PA 19148-1527
Phone (215) 334-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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

Enrollment IDStateProvider typePAC IDDetails
I20150409001146 PA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 3274851902

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211414400000",
    "number": "1063543015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1727 S BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191481527",
            "telephone_number": "215-334-2000",
            "fax_number": "215-755-7333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1727 S BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191481527",
            "telephone_number": "215-334-2000",
            "fax_number": "215-755-7333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MESTICHELLI",
        "first_name": "WILLIAM",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-08",
        "last_updated": "2008-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS022834L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.