Individual provider Active NPI

Jorge L Machicote, DMD

  • General Practice Dentistry
  • San Juan, PR
National Provider Identifier
1881796910
Registry record updated Jul 8, 2007
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Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
00889 Issued in PR
Practice address
2062 Borinouen Ave Barrio Obrero
San Juan, PR 00915
Phone
(787) 726-4988
Fax
(787) 726-4988
NPI assigned
Sep 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 00889 PR Primary

Addresses

Primary practice location

2062 Borinouen Ave Barrio Obrero
San Juan, PR 00915

Mailing address

PO Box 14306
San Juan, PR 00916-4306
Phone (787) 726-4988

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160428001698 PR Order and Referring Only - DentistPractitioner - Dentist 4385943166

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
00889PRMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1881796910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14306",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009164306",
            "telephone_number": "787-726-4988",
            "fax_number": "787-726-4988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2062 BORINOUEN AVE BARRIO OBRERO",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00915",
            "telephone_number": "787-726-4988",
            "fax_number": "787-726-4988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACHICOTE",
        "first_name": "JORGE",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PR",
            "license": "00889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

Verify at the official NPI Registry.