Active NPI
Mark Bentley Bleak, DMD
- Dentist
- Farmington, NM
National Provider Identifier
1407046360
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DD2905
- Practice address
- 1001 W Broadway Ste D
Farmington, NM 87401-5638 - Phone
- (505) 325-9133
- NPI assigned
- Jul 26, 2007
- 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 | DD2905 | NM | Primary |
Addresses
Primary practice location
1001 W Broadway Ste D
Farmington, NM 87401-5638
Mailing address
1001 W Broadway Ste D
Farmington, NM 87401-5638
Phone (505) 325-9133
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NM
- 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 |
|---|---|---|---|---|
| I20160726000585 | NM | Order and Referring Only - Dentist | 5698068856 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185408000000",
"number": "1407046360",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 W BROADWAY STE D",
"city": "FARMINGTON",
"state": "NM",
"postal_code": "874015638",
"telephone_number": "505-325-9133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 W BROADWAY STE D",
"city": "FARMINGTON",
"state": "NM",
"postal_code": "874015638",
"telephone_number": "505-325-9133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLEAK",
"first_name": "MARK",
"middle_name": "BENTLEY",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-26",
"last_updated": "2007-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NM",
"license": "DD2905",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Farmington, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2007; 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.