Active NPI
Justin Lee Mallette
- Dentist
- Asheville, NC
National Provider Identifier
1275948341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 150979
- Practice address
- 121 Hendersonville Rd
Asheville, NC 28803-2868 - Phone
- (828) 252-4290
- NPI assigned
- Jun 26, 2014
- 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 | 150979 | NC | Primary |
Addresses
Primary practice location
121 Hendersonville Rd
Asheville, NC 28803-2868
Mailing address
4221 Verde Vista Circle
Asheville, NC 28805-4522
Phone (703) 786-0459
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160629000446 | NC | Order and Referring Only - Dentist | 2769773308 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 150979 | NC | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1403740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1403740800000",
"number": "1275948341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4221 VERDE VISTA CIRCLE",
"city": "ASHEVILLE",
"state": "NC",
"postal_code": "288054522",
"telephone_number": "703-786-0459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "121 HENDERSONVILLE RD",
"city": "ASHEVILLE",
"state": "NC",
"postal_code": "288032868",
"telephone_number": "828-252-4290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLETTE",
"first_name": "JUSTIN",
"middle_name": "LEE",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-06-26",
"last_updated": "2014-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "150979",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Asheville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2014; 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.