Individual provider Active NPI

Marcelle Matos Nascimento, D.D.S.

  • General Practice Dentistry
  • East Amherst, NY
National Provider Identifier
1275706426
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DTP 497 Issued in FL
Practice address
8780 Millcreek Dr
East Amherst, NY 14051-2088
Phone
(352) 682-3431
NPI assigned
Apr 9, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DTP 497 FL Primary

Addresses

Primary practice location

8780 Millcreek Dr
East Amherst, NY 14051-2088

Mailing address

8780 Millcreek Dr
East Amherst, NY 14051-2088
Phone (352) 273-5834

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160511001534 FL Order and Referring Only - DentistPractitioner - Dentist 8921397142

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

615 Shipyard Blvd
Wilmington, NC 28412-6431

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DTP 497FLMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1275706426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8780 MILLCREEK DR",
            "city": "EAST AMHERST",
            "state": "NY",
            "postal_code": "140512088",
            "telephone_number": "352-273-5834",
            "fax_number": "352-682-3431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8780 MILLCREEK DR",
            "city": "EAST AMHERST",
            "state": "NY",
            "postal_code": "140512088",
            "telephone_number": "352-682-3431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NASCIMENTO",
        "first_name": "MARCELLE",
        "middle_name": "MATOS",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-09",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DTP 497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Amherst, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.