NPIMap

Individual provider Active NPI

Frank Mazzeo Jr., DDS

  • General Practice Dentistry
  • Fort Myers, FL
National Provider Identifier
1962597047
Registry record updated Sep 29, 2020
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Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN6062 Issued in FL
Practice address
2232 Grand Ave
Fort Myers, FL 33901-3717
Phone
(239) 344-2344
Fax
(239) 332-3372
NPI assigned
Oct 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2020

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 DN6062 FL Primary

Addresses

Primary practice location

2232 Grand Ave
Fort Myers, FL 33901-3717

Mailing address

PO Box 919771
Orlando, FL 32891-9771
Phone (239) 278-3600

Other identifiers 1

IdentifierTypeStateIssuer
071294900MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160623000068 FL Order and Referring Only - DentistPractitioner - Dentist 9638089683

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN6062FLMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of Southwest Florida, Inc. PastSince Oct 10, 2009 Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 12

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Family Health Centers of Southwest Florida IncLabelle, FL, CCN 101885 Federally qualified health center Corporate Director
W-2 Managing Employee		 Oct 1, 2009
Aug 15, 1999
Family Health Centers of Southwest Florida IncFort Myers, FL, CCN 101884 Federally qualified health center Corporate Officer
Corporate Director
W-2 Managing Employee		 Jun 15, 1999
Jun 15, 1999
Jun 15, 1999
Family Health Centers of Southwest Florida IncFort Myers, FL, CCN 101896 Federally qualified health center Corporate Director
W-2 Managing Employee		 Aug 22, 2008
Oct 1, 2009
Family Health Centers of Southwest Florida IncCape Coral, FL, CCN 101927 Federally qualified health center Corporate Director
W-2 Managing Employee		 Aug 22, 2008
Aug 22, 2008
Family Health Centers of Southwest Florida IncLehigh Acres, FL, CCN 101913 Federally qualified health center Corporate Director
W-2 Managing Employee		 Aug 22, 2008
Aug 22, 2008
Family Health Centers of Southwest Florida IncPort Charlotte, FL, CCN 101934 Federally qualified health center Corporate Director
W-2 Managing Employee		 Aug 22, 2008
Aug 22, 2008
Family Health Centers of Southwest Florida IncFort Myers, FL, CCN 101063 Federally qualified health center Corporate Director
W-2 Managing Employee		 Jun 15, 1999
Jun 15, 1999
Family Health Centers of Southwest Florida IncFort Myers, FL, CCN 101178 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jun 15, 1999
Jun 15, 1999
Family Health Centers of Southwest Florida IncBonita Springs, FL, CCN 101163 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jun 15, 1999
Jun 15, 1999
Family Health Centers of Southwest Florida IncCape Coral, FL, CCN 101179 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jun 15, 1999
Jun 15, 1999
Family Health Centers of Southwest Florida IncPort Charlotte, FL, CCN 101180 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jun 15, 1999
Jun 15, 1999
Family Health Centers of Southwest Florida IncFort Myers, FL, CCN C11067 Federally qualified health center Corporate Officer (100%) Oct 10, 2009

Owned or controlled facilities with NPI records 12

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601337600000",
    "number": "1962597047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 919771",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328919771",
            "telephone_number": "239-278-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2232 GRAND AVE",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339013717",
            "telephone_number": "239-344-2344",
            "fax_number": "239-332-3372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZEO",
        "first_name": "FRANK",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN6062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "071294900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.