Active NPI
Jeremy Keith Masenior, DDS
- General Practice Dentistry
- Princess Anne, MD
National Provider Identifier
1740508613
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 15315
- Practice address
- 12165 Elm St
Princess Anne, MD 21853-1358 - Phone
- (410) 651-5151
- Fax
- (410) 651-4256
- NPI assigned
- May 17, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 15315 | MD | Primary |
| Dentist | 122300000X | DT2403 | HI |
Addresses
Primary practice location
12165 Elm St
Princess Anne, MD 21853-1358
Mailing address
PO Box 1978
Salisbury, MD 21802-1978
Phone (410) 749-1015
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 119591300 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
- 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 |
|---|---|---|---|---|
| I20160526001373 | MD | Order and Referring Only - Other (Physician) | 4789974130 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT2403 | HI | MD | Dentist |
| 15315 | MD | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457913600000",
"number": "1740508613",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1978",
"city": "SALISBURY",
"state": "MD",
"postal_code": "218021978",
"telephone_number": "410-749-1015",
"fax_number": "410-749-0654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12165 ELM ST",
"city": "PRINCESS ANNE",
"state": "MD",
"postal_code": "218531358",
"telephone_number": "410-651-5151",
"fax_number": "410-651-4256"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASENIOR",
"first_name": "JEREMY",
"middle_name": "KEITH",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-05-17",
"last_updated": "2016-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MD",
"license": "15315",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "HI",
"license": "DT2403",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "119591300",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Princess Anne, MD
- Maple Shade Youth and Family Services, Inc.
- Donna M Markham, RDH
- Elizabeth Andrea Marshall, BA
- Sara Richelle Martin, LCSW-C
- Alexa Paige Martinelli, DMD
- Ricky Allan Mason, D.D.S
- McCready Foundation, Inc (McCready Health Imaging)
- McCready Foundation, Inc (McCready Health Immediate Care)
- Michele Yvette McIntosh
- Svetlana McLaughlin, LCSW-C
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2016; 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.