Mark A Mautner, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

NC11044 Issued in NC

Practice address

197 Point Lookout Dr
Wilkesboro, NC 28697-7451

Phone

(954) 309-7684

NPI assigned

Sep 26, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

• Advanced Dental Care of Pembroke Pines

  • Dentist
  • Pembroke Pines, FL
  • NPI 1972888782
  NPD (past)

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575244800000",
    "number": "1215038732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "197 POINT LOOKOUT DR",
            "city": "WILKESBORO",
            "state": "NC",
            "postal_code": "286977451",
            "telephone_number": "954-309-7684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "197 POINT LOOKOUT DR",
            "city": "WILKESBORO",
            "state": "NC",
            "postal_code": "286977451",
            "telephone_number": "954-309-7684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAUTNER",
        "first_name": "MARK",
        "middle_name": "A",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2019-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "9460",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "NC11044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Wilkesboro",
            "affiliation": "N",
            "address_1": "197 Point Lookout Dr",
            "city": "Wilkesboro",
            "state": "NC",
            "country_code": "US",
            "postal_code": "286977451",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Taylor Jade Luffman, LCSW-A
• Luke T. Wilson DMD PLLC
• Tiffany Rose Lunsford, MS, CCC-SLP
• Donald Lee Manus Jr., R.PH.
• Scott A Matthews, DPM, MD
• Margaret L Maycock, LPC
• Tracy Lynn McGlamery, LPTA
• Lewis Edward McNeil, NCCPSS
• Michael J. Andreski, DDS, PA
• Michael Vollmer OD PLLC

• General Practice Dentistry in Wilkesboro, NC
• Providers in Wilkesboro, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2019; 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.