Active NPI
Mark W. Todd, D.M.D., P.A.
- Endodontics
- Eustis, FL
National Provider Identifier
1104962265
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- DN-0012564
- Practice address
- 2000 Prevatt St Ste a
Eustis, FL 32726-6149 - Phone
- (352) 589-5009
- Fax
- (352) 589-5020
- NPI assigned
- Jan 29, 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | DN-0012564 | FL | Primary |
Addresses
Primary practice location
2000 Prevatt St Ste a
Eustis, FL 32726-6149
Mailing address
2000 Prevatt St Ste a
Eustis, FL 32726-6149
Phone (352) 589-5009
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
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN-0012564 | FL | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615939200000",
"number": "1104962265",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 PREVATT ST STE A",
"city": "EUSTIS",
"state": "FL",
"postal_code": "327266149",
"telephone_number": "352-589-5009",
"fax_number": "352-589-5020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 PREVATT ST STE A",
"city": "EUSTIS",
"state": "FL",
"postal_code": "327266149",
"telephone_number": "352-589-5009",
"fax_number": "352-589-5020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TODD",
"first_name": "MARK",
"middle_name": "W.",
"name_prefix": "Dr.",
"credential": "D.M.D., P.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-29",
"last_updated": "2021-03-17",
"certification_date": "2021-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "FL",
"license": "DN-0012564",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eustis, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.