Active NPI
Mark Shallal-Ayzin
- Endodontics
- Chapel Hill, NC
National Provider Identifier
1750797023
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 151001
- Practice address
- 1098 Old Dental Building
Campus Box 7450
Chapel Hill, NC 27599-0001 - Phone
- (248) 835-5343
- NPI assigned
- Jul 8, 2014
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 151001 | NC | Primary |
Addresses
Primary practice location
1098 Old Dental Building
Campus Box 7450
Chapel Hill, NC 27599-0001
Mailing address
724 N Heritage Cir
Chapel Hill, NC 27516-4203
Phone (248) 835-5343
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- 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 |
|---|---|---|---|---|
| I20170721001814 | MI | Order and Referring Only - Other (Physician) | 6800166968 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 151001 | NC | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404777600000",
"number": "1750797023",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "724 N HERITAGE CIR",
"city": "CHAPEL HILL",
"state": "NC",
"postal_code": "275164203",
"telephone_number": "248-835-5343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1098 OLD DENTAL BUILDING",
"address_2": "CAMPUS BOX 7450",
"city": "CHAPEL HILL",
"state": "NC",
"postal_code": "275990001",
"telephone_number": "248-835-5343"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHALLAL-AYZIN",
"first_name": "MARK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-07-08",
"last_updated": "2014-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NC",
"license": "151001",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chapel Hill, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2014; 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.