Active NPI
Michael Pesin, D.D.S.
- General Practice Dentistry
- Frederick, MD
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 13342
- Practice address
- 7810 Wormans Mill Rd Ste D
Frederick, MD 21701-3038 - Phone
- (301) 378-2595
- Fax
- (301) 378-2729
- NPI assigned
- Oct 12, 2006
- Last updated
- Jan 31, 2023
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 13342 | MD | Primary |
Addresses
Primary practice location
7810 Wormans Mill Rd Ste D
Frederick, MD 21701-3038
Mailing address
13420 Valley Dr
Rockville, MD 20850-3629
Phone (410) 274-4044
Other practice location 1
3420 Worthington Blvd # A
Frederick, MD 21704-7020
Phone (301) 874-6350
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 |
|---|---|---|---|
| 13342 | MD | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kopit Dental Care, PA | General Practice | Current | Accepting new patients |
| Ccdental, LLC | Current | Accepting new patients | |
| Neibauer Dental Care, PC | General Practice | Past | Accepting new patients |
Locations
3420 Worthington Blvd
#A
Frederick, MD 21704
Phone (301) 874-6350
7810 Wormans Mill Rd
Ste D
Frederick, MD 21701
Phone (301) 378-2595
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Neibauer Dental Care. - Waldorf
- General Practice Dentistry
- Waldorf, MD
- NPI 1407123045
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675123200000",
"number": "1457440174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13420 VALLEY DR",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208503629",
"telephone_number": "410-274-4044"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7810 WORMANS MILL RD STE D",
"city": "FREDERICK",
"state": "MD",
"postal_code": "217013038",
"telephone_number": "301-378-2595",
"fax_number": "301-378-2729"
}
],
"practiceLocations": [
{
"address_1": "3420 Worthington Blvd # A",
"address_purpose": "LOCATION",
"city": "Frederick",
"state": "MD",
"postal_code": "217047020",
"country_code": "US",
"telephone_number": "301-874-6350",
"fax_number": "301-874-6982",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PESIN",
"first_name": "MICHAEL",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-12",
"last_updated": "2023-01-31",
"certification_date": "2023-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MD",
"license": "13342",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Frederick, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.