Mark Anthony Iacobelli, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

30017096 Issued in OH

Practice address

8030 Corporate Circle
North Royalton, OH 44133-1245

Phone

(440) 845-7300

Fax

(440) 845-7785

NPI assigned

Mar 19, 2008

Last updated

Mar 19, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 1, 2024 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

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

• Mark a Iacobelli D D S Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • North Royalton, OH
  • NPI 1548369564
  Authorized official Same address or phone

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

{
    "created_epoch": "1205884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205884800000",
    "number": "1982875761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8030 CORPORATE CIRCLE",
            "city": "NORTH ROYALTON",
            "state": "OH",
            "postal_code": "441331245",
            "telephone_number": "440-845-7300",
            "fax_number": "440-845-7785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8030 CORPORATE CIRCLE",
            "city": "NORTH ROYALTON",
            "state": "OH",
            "postal_code": "441331245",
            "telephone_number": "440-845-7300",
            "fax_number": "440-845-7785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IACOBELLI",
        "first_name": "MARK",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-19",
        "last_updated": "2008-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30017096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in North Royalton, OH
• Providers in North Royalton, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.