Individual provider Active NPI

Marisela Lavermicocca, DMD

  • Dentist
  • Naples, FL
National Provider Identifier
1780574111
Registry record updated Oct 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN30690 Issued in FL
Practice address
6360 Pine Ridge Rd Ste 202
Naples, FL 34119-3907
Phone
(239) 354-5353
NPI assigned
Jul 7, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN30690 FL Primary
Dentist 122300000X 42054 TX

Addresses

Primary practice location

6360 Pine Ridge Rd Ste 202
Naples, FL 34119-3907

Mailing address

6360 Pine Ridge Rd Ste 202
Naples, FL 34119-3907
Phone (239) 354-5353

Other practice location 1

17026 Bulverde Rd Ste 102
San Antonio, TX 78247-4700
Phone (210) 944-8111

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

LicenseStateTypeSpecialty
DN30690FLMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Griffith Cosmetic & Family Dental Care PastSince Jul 13, 2025 Accepting new patients
San Antonio Pediatric Dentistry, PLLC Past Accepting new patients
Florida Dental Professionals, P.a. PastSince Jul 13, 2025 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1751846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760659200000",
    "number": "1780574111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6360 PINE RIDGE RD STE 202",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341193907",
            "telephone_number": "239-354-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6360 PINE RIDGE RD STE 202",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341193907",
            "telephone_number": "239-354-5353"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17026 Bulverde Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782474700",
            "country_code": "US",
            "telephone_number": "210-944-8111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAVERMICOCCA",
        "first_name": "MARISELA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-07",
        "last_updated": "2025-10-17",
        "certification_date": "2025-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN30690",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "42054",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Naples, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.