Active NPI
Gustavo Machado Santaella, DDS, MS, PHD
- Dentist
- Louisville, KY
National Provider Identifier
1639729593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10320
- Practice address
- 501 S Preston St
Louisville, KY 40202-1701 - Phone
- (502) 852-5096
- NPI assigned
- Sep 12, 2019
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 10320 | KY | Primary |
Addresses
Primary practice location
501 S Preston St
Louisville, KY 40202-1701
Mailing address
501 S Preston St RM 149M
Louisville, KY 40202-1701
Phone (502) 852-2585
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
- Credentials
- Master of Science, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10320 | KY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568246400000",
"number": "1639729593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 S PRESTON ST RM 149M",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402021701",
"telephone_number": "502-852-2585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 S PRESTON ST",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402021701",
"telephone_number": "502-852-5096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACHADO SANTAELLA",
"first_name": "GUSTAVO",
"credential": "DDS, MS, PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-12",
"last_updated": "2019-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "10320",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.