Active NPI
Mark E Mallatt, D.D.S.
- Public Health Dentistry
- Plainfield, IN
National Provider Identifier
1982986493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health Dentistry
- License
- 12007363
- Practice address
- 1753 Esther CT
Plainfield, IN 46168-9336 - Phone
- (317) 839-2862
- NPI assigned
- Sep 12, 2011
- Last updated
- Sep 12, 2011
- 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 |
|---|---|---|---|---|
| Public Health Dentistry | 1223D0001X | 12007363 | IN | Primary |
Addresses
Primary practice location
1753 Esther CT
Plainfield, IN 46168-9336
Mailing address
1753 Esther CT
Plainfield, IN 46168-9336
Phone (317) 839-2862
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 |
|---|---|---|---|
| 12007363 | IN | MD | Public Health Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315785600000",
"number": "1982986493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1753 ESTHER CT",
"city": "PLAINFIELD",
"state": "IN",
"postal_code": "461689336",
"telephone_number": "317-839-2862"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1753 ESTHER CT",
"city": "PLAINFIELD",
"state": "IN",
"postal_code": "461689336",
"telephone_number": "317-839-2862"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLATT",
"first_name": "MARK",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-09-12",
"last_updated": "2011-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223D0001X",
"taxonomy_group": "",
"desc": "Dentist, Dental Public Health",
"state": "IN",
"license": "12007363",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plainfield, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.