Active NPI
Sergio Garcia
- Dentist
- Mesa, AZ
National Provider Identifier
1649956376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D011839
- Practice address
- 1712 S Country Club Dr Ste 104
Mesa, AZ 85210-6046 - Phone
- (480) 376-0593
- NPI assigned
- Jun 27, 2023
- 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 | D011839 | AZ | Primary |
Addresses
Primary practice location
1712 S Country Club Dr Ste 104
Mesa, AZ 85210-6046
Mailing address
1028 E Fairfield St
Mesa, AZ 85203-4929
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- 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 |
|---|---|---|---|---|
| I20231024003796 | AZ | Order and Referring Only - Dentist | 7810343027 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D011839 | AZ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mesa Valley Modern Dentistry, LLP | Dentist | Past | 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.
-
- Dentist
- Mesa, AZ
- NPI 1487190880
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687824000000",
"number": "1649956376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1028 E FAIRFIELD ST",
"city": "MESA",
"state": "AZ",
"postal_code": "852034929"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1712 S COUNTRY CLUB DR STE 104",
"city": "MESA",
"state": "AZ",
"postal_code": "852106046",
"telephone_number": "480-376-0593"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARCIA",
"first_name": "SERGIO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-06-27",
"last_updated": "2023-06-27",
"certification_date": "2023-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "D011839",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; 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.