Active NPI
Mark Lee Zila, DDS
- General Practice Dentistry
- Mammoth Lakes, CA
National Provider Identifier
1902012164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 34451
- Practice address
- 549 Old Mammoth Rd.
Mammoth Lakes, CA 93546 - Phone
- (760) 934-2579
- Fax
- (760) 934-1835
- NPI assigned
- May 15, 2007
- Sex
- Male
- 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 | 34451 | CA | Primary |
Addresses
Primary practice location
549 Old Mammoth Rd.
Mammoth Lakes, CA 93546
Mailing address
PO Box 2737
Mammoth Lakes, CA 93546-2737
Phone (760) 934-2579
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34451 | Other | LICENSE # |
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 |
|---|---|---|---|
| 34451 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902012164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2737",
"city": "MAMMOTH LAKES",
"state": "CA",
"postal_code": "935462737",
"telephone_number": "760-934-2579",
"fax_number": "760-934-1835"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "549 OLD MAMMOTH RD.",
"city": "MAMMOTH LAKES",
"state": "CA",
"postal_code": "93546",
"telephone_number": "760-934-2579",
"fax_number": "760-934-1835"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZILA",
"first_name": "MARK",
"middle_name": "LEE",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "34451",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE #",
"identifier": "34451",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Mammoth Lakes, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.