Edward Salvatore Mortellaro Jr., DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DN 8061 Issued in FL

Practice address

710 Oakfield Dr
Suite 126
Brandon, FL 33511-4938

Phone

(813) 685-7733

Fax

(813) 681-9723

NPI assigned

Apr 4, 2013

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 FL

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

Practice roles

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.

• Edward S Mortellaro Jr DMD PA

  • Periodontics
  • Brandon, FL
  • NPI 1770700437
  NPD (past) Authorized official

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

{
    "created_epoch": "1365033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365033600000",
    "number": "1194068544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 OAKFIELD DR",
            "address_2": "SUITE 126",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114938",
            "telephone_number": "813-685-7733",
            "fax_number": "813-681-9723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 OAKFIELD DR",
            "address_2": "SUITE 126",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114938",
            "telephone_number": "813-685-7733",
            "fax_number": "813-681-9723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTELLARO",
        "first_name": "EDWARD",
        "middle_name": "SALVATORE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-04",
        "last_updated": "2013-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "DN 8061",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Morris
• Gregory Wayne Morris, PTA
• Lawrence Andrew Morris, PTA
• Rebecca Ann Morris, AA
• Thomasina Morris, RPH MHA
• Amber Mortillo
• Paul Mosad, DMD
• Malachi Moses
• Estephanie Lee Mosquera-Ortiz
• Gonzalo Mosquera, M.D.

• Periodontics in Brandon, FL
• Providers in Brandon, FL by specialty
• Periodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2013; 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.