Individual provider Active NPI

Michael A Reott Sr., DDS

  • Dentist
  • Maiden, NC
National Provider Identifier
1356449946
Registry record updated May 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
NC4942 Issued in NC
Practice address
Highway 321 South
Maiden, NC 28650-0615
Phone
(828) 428-3737
Fax
(704) 736-1171
NPI assigned
Sep 20, 2006
Last updated
May 20, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NC4942 NC Primary
General Practice Dentistry 1223G0001X NC4942 NC

Addresses

Primary practice location

Highway 321 South
Maiden, NC 28650-0615

Mailing address

4628 Countryside Dr
Flowery Branch, GA 30542-3671
Phone (704) 530-9729

Other identifiers 2

IdentifierTypeStateIssuer
8797342MedicaidNC
97342OtherNCBCBS

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160628002144 NC Order and Referring Only - DentistPractitioner - Dentist 9234420837

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
NC4942NCMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1356449946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4628 COUNTRYSIDE DR",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305423671",
            "telephone_number": "704-530-9729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HIGHWAY 321 SOUTH",
            "city": "MAIDEN",
            "state": "NC",
            "postal_code": "286500615",
            "telephone_number": "828-428-3737",
            "fax_number": "704-736-1171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REOTT",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "NC4942",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "NC4942",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8797342",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "97342",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maiden, NC

Sources for this page

Verify at the official NPI Registry.