Mark Alexander Dimitriu, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN30808 Issued in FL

Practice address

13700 N US Highway 441
Lady Lake, FL 32159-8980

Phone

(352) 259-0822

NPI assigned

May 8, 2023

Reactivated

Aug 25, 2025

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1683504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756080000000",
    "number": "1730879396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13700 N US HIGHWAY 441",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321598980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13700 N US HIGHWAY 441",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321598980",
            "telephone_number": "352-259-0822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIMITRIU",
        "first_name": "MARK",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-08",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-25",
        "deactivation_date": "2025-08-10",
        "reactivation_date": "2025-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN30808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Lady Lake, FL
• Providers in Lady Lake, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.