Michael Oppedisano, D.M.D.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

23102 Issued in TX

Practice address

5421 Richard Ave
Dallas, TX 75206-6713

Phone

(214) 228-1415

NPI assigned

May 1, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective May 13, 2016 through May 13, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pecan Plaza Dental, P.a.

  • General Practice Dentistry
  • Dallas, TX
  • NPI 1932257136
  NPD (past)

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

{
    "created_epoch": "1209600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329436800000",
    "number": "1497921209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5421 RICHARD AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752066713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5421 RICHARD AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752066713",
            "telephone_number": "214-228-1415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OPPEDISANO",
        "first_name": "MICHAEL",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-01",
        "last_updated": "2012-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "23102",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "TX",
            "license": "23102",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "23102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ophir LLC
• Ophthalmology Surgery Center of Dallas, LLC
• Victoria Rena Opie, QMHP-CS
• Melissa Akosua Opoku, LPC
• Michael Opoku
• Rachelle Oppel
• Jenna Nicole Oppenheim, PSYD
• Oppenheimer-Marks Services LLC
• Optical Clinic
• Optim Health Services, Inc.

• Pediatric Dentistry in Dallas, TX
• Providers in Dallas, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2012; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.