Mark W Paganini I, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

14264 Issued in MI

Practice address

1080 S Van Dyke Rd
Suite C
Bad Axe, MI 48413-9635

Phone

(989) 269-9769

Fax

(989) 269-8778

NPI assigned

Feb 15, 2007

Last updated

Jul 8, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in MI

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)

Enrolled

State licenses

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083757413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1080 S VAN DYKE RD",
            "address_2": "SUITE C",
            "city": "BAD AXE",
            "state": "MI",
            "postal_code": "484139635",
            "telephone_number": "989-269-9769",
            "fax_number": "989-269-8778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1080 S VAN DYKE RD",
            "address_2": "SUITE C",
            "city": "BAD AXE",
            "state": "MI",
            "postal_code": "484139635",
            "telephone_number": "989-269-9769",
            "fax_number": "989-269-8778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAGANINI",
        "first_name": "MARK",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "name_suffix": "I",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "14264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ann T Osentoski-Conley, BSN
• Ashley Osentoski, LMSW
• Craig Osentoski, R.PH.
• Michelle Rene Ostosh-Kroetsch, P.A.-C.
• Avelina Oxholm-Dababneh, DO
• Douglas G Pankratz, M.D.
• Liberata J Pantig, M.D.
• Wendy Meileing Parker, BCABA
• Justine Paugh, MA, CCC-SLP
• Faith Pena

• General Practice Dentistry in Bad Axe, MI
• Providers in Bad Axe, MI by specialty
• General Practice Dentistry in Michigan

• 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.