Active NPI
Luis Antonio Mendieta
- General Practice Dentistry
- Boston, MA
National Provider Identifier
1144065244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 42595
- Practice address
- 1 Kneeland St
Boston, MA 02111-1527 - Phone
- (617) 636-6828
- NPI assigned
- Jun 28, 2024
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 42595 | TX | Primary |
Addresses
Primary practice location
1 Kneeland St
Boston, MA 02111-1527
Mailing address
1 Kneeland St
Boston, MA 02111-1527
Phone (617) 636-6828
Other practice location 1
4400 N Midland Dr
Midland, TX 79707-3385
Phone (989) 486-2040
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1719532800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787616000000",
"number": "1144065244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 KNEELAND ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021111527",
"telephone_number": "617-636-6828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 KNEELAND ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021111527",
"telephone_number": "617-636-6828"
}
],
"practiceLocations": [
{
"address_1": "4400 N Midland Dr",
"address_purpose": "LOCATION",
"city": "Midland",
"state": "TX",
"postal_code": "797073385",
"country_code": "US",
"telephone_number": "989-486-2040",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MENDIETA",
"first_name": "LUIS",
"middle_name": "ANTONIO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-06-28",
"last_updated": "2026-08-25",
"certification_date": "2026-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "42595",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.