Active NPI
Marcos Lenza, DDS
- Dentist
- Jackson, MS
National Provider Identifier
1255178307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- PRV-TP-121-24
- 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
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 | 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PRV-TP-121-24 | MS | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of Mississippi - University of Mississippi Medical Center | Current | Accepting new patients | |
| State of Mississippi-University of Mississippi Medical Center | Current | Accepting new patients | |
| State of Mississippi - University of Mississippi Medical Center | Current | 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.
-
- General Acute Care Hospital
- Jackson, MS
- NPI 1154317527
-
- Prosthetic/Orthotic Supplier
- Jackson, MS
- NPI 1235019530
-
- Family Medicine Physician
- Grenada, MS
- NPI 1932538527
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; 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.