Active NPI
Mark Maltby, DMD
- Dentist
- Tampa, FL
National Provider Identifier
1063641652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN18738
- Practice address
- 5200 N Armenia Ave
Tampa, FL 33603-1408 - Phone
- (813) 354-9424
- Fax
- (813) 849-0211
- NPI assigned
- Jul 6, 2009
- 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 | DN18738 | FL | Primary |
Addresses
Primary practice location
5200 N Armenia Ave
Tampa, FL 33603-1408
Mailing address
5200 N Armenia Ave
Tampa, FL 33603-1408
Phone (813) 354-9424
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150709000439 | FL | Order and Referring Only - Dentist | 8426360199 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN18738 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246838400000",
"number": "1063641652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5200 N ARMENIA AVE",
"city": "TAMPA",
"state": "FL",
"postal_code": "336031408",
"telephone_number": "813-354-9424",
"fax_number": "813-849-0211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5200 N ARMENIA AVE",
"city": "TAMPA",
"state": "FL",
"postal_code": "336031408",
"telephone_number": "813-354-9424",
"fax_number": "813-849-0211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALTBY",
"first_name": "MARK",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-06",
"last_updated": "2009-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN18738",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2009; 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.