Active NPI
Mark L. Civin
- General Practice Dentistry
- Palm Beach Gardens, FL
National Provider Identifier
1699985176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8487
- Practice address
- 5600 Pga Blvd
Suite 102a
Palm Beach Gardens, FL 33418-3900 - Phone
- (561) 624-2224
- NPI assigned
- May 23, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8487 | FL | Primary |
Addresses
Primary practice location
5600 Pga Blvd
Suite 102a
Palm Beach Gardens, FL 33418-3900
Mailing address
5600 P.G.a. Blvd
Suite 102 a
Palm Beach Gardens, FL 33418
Phone (772) 545-9292
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- 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 |
|---|---|---|---|---|
| I20150622000453 | FL | Order and Referring Only - Oral Surgery | 5193036911 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8487 | FL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699985176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5600 P.G.A. BLVD",
"address_2": "SUITE 102 A",
"city": "PALM BEACH GARDENS",
"state": "FL",
"postal_code": "33418",
"telephone_number": "772-545-9292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5600 PGA BLVD",
"address_2": "SUITE 102A",
"city": "PALM BEACH GARDENS",
"state": "FL",
"postal_code": "334183900",
"telephone_number": "561-624-2224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CIVIN",
"first_name": "MARK",
"middle_name": "L.",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "8487",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palm Beach Gardens, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.