Active NPI
Mary V Mellard, DDS
- Dentist
- San Antonio, TX
National Provider Identifier
1851623995
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 13920
- Practice address
- 24200 W Ih 10
Suite 112
San Antonio, TX 78257-1145 - Phone
- (210) 687-1133
- Fax
- (210) 687-1132
- NPI assigned
- Jan 29, 2010
- 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 | 13920 | TX | Primary |
Addresses
Primary practice location
24200 W Ih 10
Suite 112
San Antonio, TX 78257-1145
Mailing address
24200 W Ih 10
Suite 112
San Antonio, TX 78257-1145
Phone (210) 687-1133
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13920 | TX | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264723200000",
"number": "1851623995",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24200 W IH 10",
"address_2": "SUITE 112",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782571145",
"telephone_number": "210-687-1133",
"fax_number": "210-687-1132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24200 W IH 10",
"address_2": "SUITE 112",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782571145",
"telephone_number": "210-687-1133",
"fax_number": "210-687-1132"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MELLARD",
"first_name": "MARY",
"middle_name": "V",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-01-29",
"last_updated": "2010-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "13920",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.