Individual provider Active NPI

Mark E Mahaney, DDS

  • General Practice Dentistry
  • Lockport, NY
National Provider Identifier
1952524423
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0377991 Issued in NY
Practice address
59 Elizabeth Drive
Lockport, NY 14094
Phone
(716) 433-8332
Fax
(716) 433-8370
NPI assigned
Apr 11, 2007
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 0377991 NY Primary

Addresses

Primary practice location

59 Elizabeth Drive
Lockport, NY 14094

Mailing address

59 Elizabeth Drive
Lockport, NY 14094
Phone (716) 433-8332

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20160126001072 NY Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 6800199803

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0377991NYMDGeneral Practice Dentistry
037799NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Clover Leaf Dental PLLC PastSince Mar 19, 2023 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952524423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 ELIZABETH DRIVE",
            "city": "LOCKPORT",
            "state": "NY",
            "postal_code": "14094",
            "telephone_number": "716-433-8332",
            "fax_number": "716-433-8370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 ELIZABETH DRIVE",
            "city": "LOCKPORT",
            "state": "NY",
            "postal_code": "14094",
            "telephone_number": "716-433-8332",
            "fax_number": "716-433-8370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHANEY",
        "first_name": "MARK",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "0377991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lockport, NY

Sources for this page

Verify at the official NPI Registry.