Active NPI
Mickel Ashraf Gerges, D.D.S.
- Dentist
- San Juan Capistrano, CA
National Provider Identifier
1457794109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 62273
- Practice address
- 30300 Camino Capistrano
San Juan Capistrano, CA 92675-1304 - Phone
- (949) 306-5482
- NPI assigned
- Apr 12, 2013
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 62273 | CA | Primary |
Addresses
Primary practice location
30300 Camino Capistrano
San Juan Capistrano, CA 92675-1304
Mailing address
30300 Camino Capistrano
San Juan Capistrano, CA 92675-1304
Phone (949) 306-5482
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- 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 |
|---|---|---|---|---|
| I20160223000688 | CA | Order and Referring Only - Dentist | 7618272089 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62273 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1365724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551744000000",
"number": "1457794109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30300 CAMINO CAPISTRANO",
"city": "SAN JUAN CAPISTRANO",
"state": "CA",
"postal_code": "926751304",
"telephone_number": "949-306-5482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30300 CAMINO CAPISTRANO",
"city": "SAN JUAN CAPISTRANO",
"state": "CA",
"postal_code": "926751304",
"telephone_number": "949-306-5482"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GERGES",
"first_name": "MICKEL",
"middle_name": "ASHRAF",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-04-12",
"last_updated": "2019-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "62273",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Juan Capistrano, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2019; 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.