NPIMap

Individual provider Active NPI

Steven J Marcello, DDS

  • Pediatric Dentistry
  • Thibodaux, LA
National Provider Identifier
1275680944
Registry record updated Nov 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
3570 Issued in LA
Practice address
156 W Main St
Thibodaux, LA 70301-5216
Phone
(985) 446-3754
Fax
(985) 449-1582
NPI assigned
Jan 4, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 3, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 3570 LA Primary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 3570 LA

Addresses

Primary practice location

156 W Main St
Thibodaux, LA 70301-5216

Mailing address

156 W Main St
Thibodaux, LA 70301-5216
Phone (985) 446-3754

Other identifiers 2

IdentifierTypeStateIssuer
1174753321MedicaidLA
1275680944MedicaidLA

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

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320278400000",
    "number": "1275680944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "156 W MAIN ST",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703015216",
            "telephone_number": "985-446-3754",
            "fax_number": "985-449-1582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 W MAIN ST",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703015216",
            "telephone_number": "985-446-3754",
            "fax_number": "985-449-1582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARCELLO",
        "first_name": "STEVEN",
        "middle_name": "J",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2011-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "LA",
            "license": "3570",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "LA",
            "license": "3570",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174753321",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275680944",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thibodaux, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; 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.