Mitchel Gavino, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D15011 Issued in MN

Practice address

1501 E 10TH St Ste 213
Atlantic, IA 50022-1936

Phone

(612) 968-3576

NPI assigned

Sep 17, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1568678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698796800000",
    "number": "1508416017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 E 10TH ST STE 213",
            "city": "ATLANTIC",
            "state": "IA",
            "postal_code": "500221936",
            "telephone_number": "612-968-3576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 E 10TH ST STE 213",
            "city": "ATLANTIC",
            "state": "IA",
            "postal_code": "500221936",
            "telephone_number": "612-968-3576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAVINO",
        "first_name": "MITCHEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-17",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IA",
            "license": "DDS-09710",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D15011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roland J Flory, DPM
• Lana Frain
• Erin Christine Fray
• Melissa Jo Frazier, DNP ARNP
• Megan Marie Frederiksen, ARNP
• Louis P Gerbino, M.D.
• Jeffrey Michael Goergen, O.D.
• Patricia Lynn Goodemote, MD
• Brent F Goodrich, CRNA
• Carol Jane Graves

• All providers in Atlantic, IA
• Dentist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; 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.

Verify at the official NPI Registry.