Active NPI
Michael Joseph Marcello II, DDS,MS
- Endodontics
- Thibodaux, LA
National Provider Identifier
1669789335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 5947
- Practice address
- 117 Saint Michael St
Thibodaux, LA 70301-3437 - Phone
- (985) 625-3636
- NPI assigned
- Sep 1, 2010
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 5947 | LA | Primary |
Addresses
Primary practice location
117 Saint Michael St
Thibodaux, LA 70301-3437
Mailing address
824 Ridgefield Rd
Thibodaux, LA 70301-2726
Phone (985) 625-3636
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5947 | LA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473292800000",
"number": "1669789335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "824 RIDGEFIELD RD",
"city": "THIBODAUX",
"state": "LA",
"postal_code": "703012726",
"telephone_number": "985-625-3636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 SAINT MICHAEL ST",
"city": "THIBODAUX",
"state": "LA",
"postal_code": "703013437",
"telephone_number": "985-625-3636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARCELLO",
"first_name": "MICHAEL",
"middle_name": "JOSEPH",
"name_suffix": "II",
"credential": "DDS,MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-09-01",
"last_updated": "2016-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "LA",
"license": "5947",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Thibodaux, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.