Active NPI
Macario Melvin Gentile III, DDS
- General Practice Dentistry
- Mesa, AZ
National Provider Identifier
1912900705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1991
- Practice address
- 2135 E University Dr
Ste 115
Mesa, AZ 85213-8335 - Phone
- (480) 969-6762
- Fax
- (480) 833-5739
- NPI assigned
- May 24, 2005
- 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 | 1991 | AZ | Primary |
Addresses
Primary practice location
2135 E University Dr
Ste 115
Mesa, AZ 85213-8335
Mailing address
2135 E University Dr
Ste 115
Mesa, AZ 85213-8335
Phone (480) 969-6762
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0762858 | Other | PA | UNITED CONCORDIA |
| 0127770 | Other | AZ | BLUE/BLUE SHIELD |
| 1991 | Other | AZ | DELTA DENTAL |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190592000000",
"number": "1912900705",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2135 E UNIVERSITY DR",
"address_2": "STE 115",
"city": "MESA",
"state": "AZ",
"postal_code": "852138335",
"telephone_number": "480-969-6762",
"fax_number": "480-833-5739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2135 E UNIVERSITY DR",
"address_2": "STE 115",
"city": "MESA",
"state": "AZ",
"postal_code": "852138335",
"telephone_number": "480-969-6762",
"fax_number": "480-833-5739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENTILE",
"first_name": "MACARIO",
"middle_name": "MELVIN",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-05-24",
"last_updated": "2007-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AZ",
"license": "1991",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "0762858",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE/BLUE SHIELD",
"identifier": "0127770",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DELTA DENTAL",
"identifier": "1991",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 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.