Mike H Marcantonio, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN16776 Issued in FL

Practice address

4272 Avalon Blvd
Milton, FL 32583-2808

Phone

(850) 626-6100

NPI assigned

May 24, 2007

Sex

Male

Sole proprietor

No

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.

• Avalon Dental Clinic PL

  • General Practice Dentistry
  • Milton, FL
  • NPI 1629045489

  General Practice

  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508077397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 HIDDEN LAKES DR E",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325784180",
            "telephone_number": "850-420-6750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4272 AVALON BLVD",
            "city": "MILTON",
            "state": "FL",
            "postal_code": "325832808",
            "telephone_number": "850-626-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARCANTONIO",
        "first_name": "MIKE",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN16776",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1941867",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Renee Mahute, RPH
• Cynthia Maillet, RN
• Gloria Margarita Malpica Hamilton, FNP-C
• Carl Maltese, ARNP
• Annalisa Hope Marcantonio, LCSW
• Mark J Elder DO PA
• Claire Marx, DC
• Danielle Nicole Matthews, RBT
• Roger Matthews
• Ann Mignon Mattingly Gillis, M.ED

• All providers in Milton, FL
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.