Gary Michael Lease, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN13231 Issued in FL

Practice address

1296 W Broad St
Groveland, FL 34736-2012

Phone

(407) 905-8827

Fax

(352) 429-1257

NPI assigned

Jul 11, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313625600000",
    "number": "1316945751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1249",
            "city": "APOPKA",
            "state": "FL",
            "postal_code": "327041249",
            "telephone_number": "407-905-8827",
            "fax_number": "407-905-8998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1296 W BROAD ST",
            "city": "GROVELAND",
            "state": "FL",
            "postal_code": "347362012",
            "telephone_number": "407-905-8827",
            "fax_number": "352-429-1257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEASE",
        "first_name": "GARY",
        "middle_name": "MICHAEL",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-11",
        "last_updated": "2011-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN13231",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "071836000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Groveland, FL
• Providers in Groveland, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2011; 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.

Verify at the official NPI Registry.