Individual provider Active NPI

Mrinal Ganti

  • Dentist
  • Tucson, AZ
National Provider Identifier
1467139394
Registry record updated Jul 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D011878 Issued in AZ
Practice address
1979 W Valencia Rd
Tucson, AZ 85746-6633
Phone
(720) 545-3608
NPI assigned
Jul 3, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D011878 AZ Primary

Addresses

Primary practice location

1979 W Valencia Rd
Tucson, AZ 85746-6633

Mailing address

5525 S Mission Rd Apt 2201
Tucson, AZ 85746-2278
Phone (207) 413-8064

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
D011878AZMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1688342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688342400000",
    "number": "1467139394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5525 S MISSION RD APT 2201",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857462278",
            "telephone_number": "207-413-8064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1979 W VALENCIA RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857466633",
            "telephone_number": "720-545-3608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANTI",
        "first_name": "MRINAL",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-03",
        "last_updated": "2023-07-03",
        "certification_date": "2023-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D011878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 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.

Verify at the official NPI Registry.