Individual provider Active NPI

Marcos Lenza, DDS

  • Dentist
  • Jackson, MS
National Provider Identifier
1255178307
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
PRV-TP-121-24 Issued in MS
Practice address
2500 N State St
Jackson, MS 39216-4500
Phone
(601) 815-2005
NPI assigned
Jul 15, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X PRV-TP-121-24 MS Primary

Addresses

Primary practice location

2500 N State St
Jackson, MS 39216-4500

Mailing address

504 Clinton Center Dr Ste 4300
Clinton, MS 39056-5610

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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

Enrollment IDStateProvider typePAC IDDetails
I20241029000743 MS Practitioner - Orthodontics and Dentofacial Orthopedics 6204369325 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PRV-TP-121-24MSMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
State of Mississippi - University of Mississippi Medical Center Current Accepting new patients
State of Mississippi-University of Mississippi Medical Center CurrentSince Sep 16, 2024 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Sep 16, 2024 Accepting new patients

Locations

504 Clinton Center Dr
Ste 4300
Clinton, MS 39056

965 Avent Dr
Ste 100A
Grenada, MS 38901
Phone (662) 227-7000

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1721001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1255178307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 CLINTON CENTER DR STE 4300",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390565610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-815-2005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LENZA",
        "first_name": "MARCOS",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-15",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "PRV-TP-121-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.