Individual provider Active NPI

Hannah Elisabeth Mixter, DMD

  • General Practice Dentistry
  • Santa Cruz, CA
National Provider Identifier
1578093233
Registry record updated Jun 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
101419 Issued in CA
Practice address
1830 Commercial Way
Santa Cruz, CA 95065-1819
Phone
(831) 464-5409
NPI assigned
Jun 15, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 101419 CA Primary

Addresses

Primary practice location

1830 Commercial Way
Santa Cruz, CA 95065-1819

Mailing address

9560 SW Ardenwood St
Portland, OR 97225-4907
Phone (603) 686-1776

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20170911001439 CA Order and Referring Only - DentistPractitioner - Dentist 6901179191

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Dientes Community Dental Care. PastSince Jun 21, 2022 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1497484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1578093233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9560 SW ARDENWOOD ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972254907",
            "telephone_number": "603-686-1776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 COMMERCIAL WAY",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651819",
            "telephone_number": "831-464-5409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIXTER",
        "first_name": "HANNAH",
        "middle_name": "ELISABETH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-15",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "101419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Cruz, CA

Sources for this page

Verify at the official NPI Registry.