Active NPI
Mariah Madison Demelo, DDS
- Dentist
- Detroit, MI
National Provider Identifier
1770470486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901602568
- Practice address
- 4201 Saint Antoine St
Detroit, MI 48201-2153 - Phone
- (313) 745-3000
- NPI assigned
- Jun 24, 2025
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 2901602568 | MI | Primary |
Addresses
Primary practice location
4201 Saint Antoine St
Detroit, MI 48201-2153
Mailing address
1611 Michigan Ave Unit 322
Detroit, MI 48216-2318
Phone (519) 566-9151
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 |
|---|---|---|---|---|
| I20250707003890 | MI | Order and Referring Only - Dentist | 4082128616 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1750723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750723200000",
"number": "1770470486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1611 MICHIGAN AVE UNIT 322",
"city": "DETROIT",
"state": "MI",
"postal_code": "482162318",
"telephone_number": "519-566-9151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4201 SAINT ANTOINE ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012153",
"telephone_number": "313-745-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEMELO",
"first_name": "MARIAH",
"middle_name": "MADISON",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-06-24",
"last_updated": "2025-06-24",
"certification_date": "2025-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901602568",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2025; 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.