Active NPI
Mallory Mayeda
- General Practice Dentistry
- Frisco, CO
National Provider Identifier
1770117368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DEN.00204670
- Practice address
- 360 Peak One Dr Ste 325
Frisco, CO 80443-5948 - Phone
- (970) 668-4045
- NPI assigned
- Feb 24, 2020
- Last updated
- Jul 13, 2022
- Sex
- Female
- 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 | DEN.00204670 | CO | Primary |
Addresses
Primary practice location
360 Peak One Dr Ste 325
Frisco, CO 80443-5948
Mailing address
15804 W 63Rd Ave
Arvada, CO 80403-2145
Phone (303) 990-2989
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DEN.00204670 | CO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657670400000",
"number": "1770117368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15804 W 63RD AVE",
"city": "ARVADA",
"state": "CO",
"postal_code": "804032145",
"telephone_number": "303-990-2989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "360 PEAK ONE DR STE 325",
"city": "FRISCO",
"state": "CO",
"postal_code": "804435948",
"telephone_number": "970-668-4045"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYEDA",
"first_name": "MALLORY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-02-24",
"last_updated": "2022-07-13",
"certification_date": "2022-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CO",
"license": "DEN.00204670",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Frisco, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.