Michael John Mack, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

005247 Issued in CT

Practice address

40 E. Putnam Ave.
Cos Cob, CT 06807

Phone

(203) 661-2279

Fax

(203) 869-2261

NPI assigned

Oct 5, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

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": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508952375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 E. PUTNAM AVE.",
            "city": "COS COB",
            "state": "CT",
            "postal_code": "06807",
            "telephone_number": "203-661-2279",
            "fax_number": "203-869-2261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 E. PUTNAM AVE.",
            "city": "COS COB",
            "state": "CT",
            "postal_code": "06807",
            "telephone_number": "203-661-2279",
            "fax_number": "203-869-2261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "005247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary M Lennon, LPC
• Ronald M Levine, MD
• Christopher Licata
• Tangley Canpbell Lloyd, LCSW
• Christine J Lynders, PT
• Rafael Gerardo Magana, M.D.
• Robert Mahlman
• Melissa K Malone, PNP
• Alessandra Nicole Mangold, OTR
• Amanda Maniscalco, CCC-SLP

• General Practice Dentistry in Cos Cob, CT
• Providers in Cos Cob, CT by specialty
• General Practice Dentistry in Connecticut

• 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.
• 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.