Active NPI
Josh Mayo
- Dentist
- Philadelphia, PA
National Provider Identifier
1225792708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10672
- Practice address
- 3400 Civic Center Blvd
Philadelphia, PA 19104-5127 - Phone
- (215) 662-3580
- NPI assigned
- Oct 29, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS044342 | PA | |
| Dentist | 122300000X | 10672 | KY | Primary |
Addresses
Primary practice location
3400 Civic Center Blvd
Philadelphia, PA 19104-5127
Mailing address
2400 Mellwood Ave Apt 420
Louisville, KY 40206-1064
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10672 | KY | MD | Dentist |
| DS044342 | PA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ocean Dental of Kentucky | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Louisville, KY
- NPI 1043438062
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1635465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719273600000",
"number": "1225792708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2400 MELLWOOD AVE APT 420",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402061064"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 CIVIC CENTER BLVD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191045127",
"telephone_number": "215-662-3580"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYO",
"first_name": "JOSH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-10-29",
"last_updated": "2024-06-25",
"certification_date": "2024-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS044342",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "10672",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.