Arley Medrano, DDS, MS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

39259 Issued in TX

Practice address

711 S Clay St Ste a
Ennis, TX 75119-5748

Phone

(972) 875-5437

NPI assigned

Aug 27, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685059200000",
    "number": "1669953774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2422 GLENGARIFF DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752282934",
            "telephone_number": "509-322-5320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 S CLAY ST STE A",
            "city": "ENNIS",
            "state": "TX",
            "postal_code": "751195748",
            "telephone_number": "972-875-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDRANO",
        "first_name": "ARLEY",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-08-27",
        "last_updated": "2023-05-26",
        "certification_date": "2023-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60884780",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "DE60884780",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "39259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natasha Mazaheri, D.C.
• Dianne Sharon McKenzie, M.D.
• Tanya Yvonne McNamee, LVN
• Med Southwest, PLLC
• Medical and Surgical Associates of Corsicana
• Meg Sullivan, M.D., PA
• Daniel Miller
• Jacquelyn L Minchew, LPC
• Joshua D Montney, PHARM.D.
• Calvin Brent Morelock, COTA

• Pediatric Dentistry in Ennis, TX
• Providers in Ennis, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 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.

Verify at the official NPI Registry.