Active NPI
Mackenzie H Neuville, DMD
- Pediatric Dentistry
- Tavares, FL
National Provider Identifier
1568191955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DN28954
- Practice address
- 2714 Dora Ave
Tavares, FL 32778-4970 - Phone
- (352) 483-9183
- NPI assigned
- Jun 9, 2022
- Last updated
- May 5, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 10801 | KY | |
| Pediatric Dentistry | 1223P0221X | DN28954 | FL | Primary |
Addresses
Primary practice location
2714 Dora Ave
Tavares, FL 32778-4970
Mailing address
2714 Dora Ave
Tavares, FL 32778-4970
Phone (352) 483-9183
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN28954 | FL | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1746403200000",
"number": "1568191955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2714 DORA AVE",
"city": "TAVARES",
"state": "FL",
"postal_code": "327784970",
"telephone_number": "352-483-9183"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2714 DORA AVE",
"city": "TAVARES",
"state": "FL",
"postal_code": "327784970",
"telephone_number": "352-483-9183"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEUVILLE",
"first_name": "MACKENZIE",
"middle_name": "H",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-06-09",
"last_updated": "2025-05-05",
"certification_date": "2025-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "10801",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "FL",
"license": "DN28954",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tavares, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2025; 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.