Active NPI
Michael Addair Tarver, DMD
- Pediatric Dentistry
- Clermont, FL
National Provider Identifier
1396973046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DN18670
- Practice address
- 1397 W Lakeshore Dr
Clermont, FL 34711-2939 - Phone
- (352) 404-5105
- NPI assigned
- Jul 1, 2009
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DN18670 | FL | Primary |
Addresses
Primary practice location
1397 W Lakeshore Dr
Clermont, FL 34711-2939
Mailing address
1397 W Lakeshore Dr
Clermont, FL 34711-2939
Phone (863) 899-1617
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002880000 | Medicaid | FL |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN18670 | FL | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490918400000",
"number": "1396973046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1397 W LAKESHORE DR",
"city": "CLERMONT",
"state": "FL",
"postal_code": "347112939",
"telephone_number": "863-899-1617"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1397 W LAKESHORE DR",
"city": "CLERMONT",
"state": "FL",
"postal_code": "347112939",
"telephone_number": "352-404-5105"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TARVER",
"first_name": "MICHAEL",
"middle_name": "ADDAIR",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-07-01",
"last_updated": "2017-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "FL",
"license": "DN18670",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002880000",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clermont, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.