Active NPI
Mark Keyan Tadrissi, D.D.S.
- Endodontics
- Charlotte, NC
National Provider Identifier
1619907508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 9377
- Practice address
- 14135 Balntyn Corp PL Ste 215
Charlotte, NC 28277-4452 - Phone
- (704) 541-7017
- NPI assigned
- Jul 4, 2006
- Last updated
- Jun 23, 2026
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 9377 | NC | Primary |
Addresses
Primary practice location
14135 Balntyn Corp PL Ste 215
Charlotte, NC 28277-4452
Mailing address
14135 Balntyn Corp PL Ste 215
Charlotte, NC 28277-4452
Phone (704) 541-7017
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150721002312 | NC | Order and Referring Only - Other (Physician) | 8729391602 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sufia Palluck DDS LTD. | General Practice | Past | Accepting new patients |
Organizations & group practices 2
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": "1151971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782172800000",
"number": "1619907508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14135 BALNTYN CORP PL STE 215",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282774452",
"telephone_number": "704-541-7017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14135 BALNTYN CORP PL STE 215",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282774452",
"telephone_number": "704-541-7017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TADRISSI",
"first_name": "MARK",
"middle_name": "KEYAN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-04",
"last_updated": "2026-06-23",
"certification_date": "2026-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NC",
"license": "9377",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
- Armand Tadjali, MD
- Jordan Elise Tadlock, MMFT
- Tadpole Pediatric Therapy Services PLLC
- Tadrissi DDS, PLLC (Queen City Endodontics - South Charlotte)
- Tadrissi DDS, PLLC (Queen City Endodontics - Hutcheson)
- Arti Ajmani Taggar, MD
- Daniel Garth Tagge, MD
- Tah Family Corp (Nolans Pharmacy)
- Amir Magdy Abdelrouf Taha, DMD
- Tailor Made Care Services Group
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2026; 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.