Active NPI
Prenard Rainey Mickens, D.D.S.
- Endodontics
- Greensboro, NC
National Provider Identifier
1942499207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 7637
- Practice address
- 1416 Yanceyville St
Suite 2
Greensboro, NC 27405-6955 - Phone
- (917) 805-8509
- NPI assigned
- Oct 23, 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 7637 | NC | Primary |
Addresses
Primary practice location
1416 Yanceyville St
Suite 2
Greensboro, NC 27405-6955
Mailing address
300 W 135TH St Apt 7D
New York, NY 10030-2760
Phone (212) 234-6978
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 |
|---|---|---|---|
| 7637 | NC | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193097600000",
"number": "1942499207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 W 135TH ST APT 7D",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100302760",
"telephone_number": "212-234-6978"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1416 YANCEYVILLE ST",
"address_2": "SUITE 2",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274056955",
"telephone_number": "917-805-8509"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICKENS",
"first_name": "PRENARD",
"middle_name": "RAINEY",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-23",
"last_updated": "2007-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NC",
"license": "7637",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greensboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 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.