Individual provider Active NPI

Ann Marie Mancini, D.M.D.

  • General Practice Dentistry
  • Waterbury, CT
National Provider Identifier
1740476894
Registry record updated Sep 22, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
009741 Issued in CT
Practice address
26 Lakeside Blvd E
Waterbury, CT 06708-2968
Phone
(203) 575-9097
NPI assigned
Sep 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 009741 CT Primary

Addresses

Primary practice location

26 Lakeside Blvd E
Waterbury, CT 06708-2968

Mailing address

26 Lakeside Blvd E
Waterbury, CT 06708-2968
Phone (203) 575-9097

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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

Enrollment IDStateProvider typePAC IDDetails
I20160209002482 CT Order and Referring Only - DentistPractitioner - Dentist 2567766793

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
009741CTMDGeneral Practice Dentistry
9741CTMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Luciano D. Marini, DMD LLC General Practice 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.

NPI Registry JSON

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

{
    "created_epoch": "1190419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190419200000",
    "number": "1740476894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 LAKESIDE BLVD E",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082968",
            "telephone_number": "203-575-9097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 LAKESIDE BLVD E",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082968",
            "telephone_number": "203-575-9097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCINI",
        "first_name": "ANN MARIE",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-22",
        "last_updated": "2007-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "009741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

Verify at the official NPI Registry.