Active NPI
Lawrence Mintzer
- Dentist
- Dearborn, MI
National Provider Identifier
1649609587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901010768
- Practice address
- 23100 Cherry Hill St
Suite 2
Dearborn, MI 48124-1493 - Phone
- (313) 274-5060
- NPI assigned
- Nov 1, 2013
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 2901010768 | MI | Primary |
Addresses
Primary practice location
23100 Cherry Hill St
Suite 2
Dearborn, MI 48124-1493
Mailing address
23100 Cherry Hill St
Suite 2
Dearborn, MI 48124-1493
Phone (313) 274-5060
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- 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 |
|---|---|---|---|---|
| I20150126001090 | MI | Order and Referring Only - Oral Surgery | 9133443054 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383264000000",
"number": "1649609587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23100 CHERRY HILL ST",
"address_2": "SUITE 2",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481241493",
"telephone_number": "313-274-5060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23100 CHERRY HILL ST",
"address_2": "SUITE 2",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481241493",
"telephone_number": "313-274-5060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINTZER",
"first_name": "LAWRENCE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-11-01",
"last_updated": "2013-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901010768",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2013; 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.