NPIMap

Individual provider Active NPI

Marissa Pasion Mandap, DMD

  • General Practice Dentistry
  • Mesa, AZ
National Provider Identifier
1104018886
Registry record updated Aug 15, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7325 Issued in AZ
Practice address
846 S Stapley Dr
Mesa, AZ 85204-4243
Phone
(480) 834-8405
NPI assigned
Aug 15, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 15, 2007

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 7325 AZ Primary

Addresses

Primary practice location

846 S Stapley Dr
Mesa, AZ 85204-4243

Mailing address

846 S Stapley Dr
Mesa, AZ 85204-4243
Phone (480) 834-8405

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

Practice roles

OrganizationSpecialtyStatusNew patients
Squaw Peak Anesthesia Inc Past Accepting new patients
Care for Kids of Arizona General Practice Past Accepting new patients
Care for Kids of Arizona, LLC General Practice Past Accepting new patients
Care for Kids of Arizona, LLC General Practice Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1187136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187136000000",
    "number": "1104018886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "846 S STAPLEY DR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852044243",
            "telephone_number": "480-834-8405",
            "fax_number": "480-464-6256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "846 S STAPLEY DR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852044243",
            "telephone_number": "480-834-8405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDAP",
        "first_name": "MARISSA",
        "middle_name": "PASION",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-15",
        "last_updated": "2007-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "7325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 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.

Verify at the official NPI Registry.