Active NPI
Kervin Brandon Mack, PHARM.D., D.M.D.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Burlington, NC
National Provider Identifier
1316237290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 8824
- Practice address
- 1628 Memorial Dr
#C
Burlington, NC 27215-3592 - Phone
- (336) 227-5594
- NPI assigned
- Apr 13, 2011
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 8824 | NC | Primary |
Addresses
Primary practice location
1628 Memorial Dr
#C
Burlington, NC 27215-3592
Mailing address
1628 Memorial Dr
#C
Burlington, NC 27215-3592
Phone (336) 227-5594
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5918330 | Medicaid | NC |
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8824 | NC | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kervin Mack DMD Ms PLLC | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Orthodontics and Dentofacial Orthopedics Dentistry
- Burlington, NC
- NPI 1356688857
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353110400000",
"number": "1316237290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1628 MEMORIAL DR",
"address_2": "#C",
"city": "BURLINGTON",
"state": "NC",
"postal_code": "272153592",
"telephone_number": "336-227-5594"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1628 MEMORIAL DR",
"address_2": "#C",
"city": "BURLINGTON",
"state": "NC",
"postal_code": "272153592",
"telephone_number": "336-227-5594"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "KERVIN",
"middle_name": "BRANDON",
"name_prefix": "Dr.",
"credential": "PHARM.D., D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-04-13",
"last_updated": "2012-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "NC",
"license": "8824",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5918330",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burlington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.