Individual provider Active NPI

Mark Sameh Naguib Mekhail, DDS

  • General Practice Dentistry
  • Avon, OH
National Provider Identifier
1407433139
Registry record updated Dec 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0401417854 Issued in VA
Practice address
36050 Detroit Rd Ste T
Avon, OH 44011-1685
Phone
(440) 870-6486
NPI assigned
Mar 27, 2021
Last updated
Dec 16, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 16, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 0401417854 VA Primary
General Practice Dentistry 1223G0001X 30.028237 OH

Addresses

Primary practice location

36050 Detroit Rd Ste T
Avon, OH 44011-1685

Mailing address

11126 Light Guard Loop
Manassas, VA 20109-7635
Phone (703) 870-6403

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

LicenseStateTypeSpecialty
30.028237OHMDGeneral Practice Dentistry
0401417854VAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1616803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765843200000",
    "number": "1407433139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11126 LIGHT GUARD LOOP",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201097635",
            "telephone_number": "703-870-6403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36050 DETROIT RD STE T",
            "city": "AVON",
            "state": "OH",
            "postal_code": "440111685",
            "telephone_number": "440-870-6486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEKHAIL",
        "first_name": "MARK",
        "middle_name": "SAMEH NAGUIB",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-27",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401417854",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.028237",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Avon, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.