Active NPI
Michael John McCracken, DDS
- Dentist
- Mandeville, LA
National Provider Identifier
1245456748
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4365
- Practice address
- 1200 W Causeway Approach
Mandeville, LA 70471-3066 - Phone
- (985) 674-4441
- Fax
- (985) 674-4442
- NPI assigned
- Apr 17, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 4365 | LA | Primary |
Addresses
Primary practice location
1200 W Causeway Approach
Mandeville, LA 70471-3066
Mailing address
1302 Rue Beauvais
Mandeville, LA 70471-1235
Phone (985) 624-8559
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 |
|---|---|---|---|
| 4365 | LA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245456748",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1302 RUE BEAUVAIS",
"city": "MANDEVILLE",
"state": "LA",
"postal_code": "704711235",
"telephone_number": "985-624-8559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 W CAUSEWAY APPROACH",
"city": "MANDEVILLE",
"state": "LA",
"postal_code": "704713066",
"telephone_number": "985-674-4441",
"fax_number": "985-674-4442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCRACKEN",
"first_name": "MICHAEL",
"middle_name": "JOHN",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "LA",
"license": "4365",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mandeville, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.