Active NPI
Michael Ciccarelli
- General Practice Dentistry
- Davis, CA
National Provider Identifier
1548689599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 62563
- Practice address
- 2800 5TH St Ste 100
Davis, CA 95618-7765 - Phone
- (530) 756-5300
- NPI assigned
- Apr 7, 2014
- Last updated
- Apr 7, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 62563 | CA | Primary |
Addresses
Primary practice location
2800 5TH St Ste 100
Davis, CA 95618-7765
Mailing address
2800 5TH St Ste 100
Davis, CA 95618-7765
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
| License | State | Type | Specialty |
|---|---|---|---|
| 62563 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dagon Jones DDS Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1396828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1396828800000",
"number": "1548689599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2800 5TH ST STE 100",
"city": "DAVIS",
"state": "CA",
"postal_code": "956187765"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 5TH ST STE 100",
"city": "DAVIS",
"state": "CA",
"postal_code": "956187765",
"telephone_number": "530-756-5300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CICCARELLI",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-04-07",
"last_updated": "2014-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "62563",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davis, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.