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DR. MICHAEL CHARLES MISTRETTA D.D.S., M.D.
NPI 1780602920
Oral & Maxillofacial Surgery in New York, NY

Active since July 17, 2006Opted out of Medicare · through May 30, 2028
200 CENTRAL PARK S, SUITE 105, NEW YORK, NY 10019(212) 245-3292(212) 245-8758 Get Directions Write a Review

NPPES record last updated: April 21, 2025. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Dr. Michael Charles Mistretta D.d.s., M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MICHAEL CHARLES MISTRETTA D.D.S., M.D. (NPI 1780602920) is an individual oral & maxillofacial surgery provider in New York, New York, licensed in New York (240428-1) and active in the NPI registry since July 2006. He has opted out of Medicare through May 30, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1780602920
Entity TypeIndividualMale
Primary Taxonomy204E00000X
Provider Legal NameDR. MICHAEL CHARLES MISTRETTACredential: D.D.S., M.D.
Location Address200 CENTRAL PARK S, SUITE 105New York, NY 10019-1436
Mailing Address200 Central Park S, Suite 105New York, NY 10019-1436 · (212) 245-3292 · Fax (212) 245-8758
Phone(212) 245-3292
Fax(212) 245-8758
Sole ProprietorNo
Enumeration DateJuly 17, 2006
Last NPPES UpdateApril 21, 2025
NPPES CertifiedApril 21, 2025
✔ NPI 1780602920 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyOral & Maxillofacial SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code204E00000X
License✔ Licensed in NY · 240428-1
Definition
Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery.
Also ListedDentist · Oral and Maxillofacial SurgeryTaxonomy 1223S0112X · License 049087-1 (NY)
200 CENTRAL PARK S, New York, NY 10019
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Michael Charles Mistretta D.d.s., M.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from May 30, 2014 through May 30, 2028.

Opt-Out Effective DateMay 30, 2014
Opt-Out In Effect ThroughMay 30, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. HARRY STRULOVICI M.D.
Plastic Surgery
200 CENTRAL PARK S, SUITE # 16A
NEW YORK, NY 10019
New York County (212) 246-7890
DR. ROBERT I. SCHWARTZ D.M.D.
Dentist
200 CENTRAL PARK S, SUITE 212
NEW YORK, NY 10019
New York County (212) 541-9500
ADVANCED DERMATOLOGY OF NEW YORK PC
Dermatology
200 CENTRAL PARK S, STE 107
NEW YORK, NY 10019
New York County (212) 262-2500
LAWRENCE D JAEGER SR. DO
Dermatology
200 CENTRAL PARK S, STE 107
NEW YORK, NY 10019
New York County (212) 262-2500
PARK WEST DENTAL PC
Dentist
200 CENTRAL PARK S, SUITE 102
NEW YORK, NY 10019
New York County (212) 757-1370
KAYHAN CIVELEK DDS MS
Dentist (Periodontics)
200 CENTRAL PARK S, SUITE 209
NEW YORK, NY 10019
New York County (646) 557-0317
MR. MATTHEW HISLOP PA
Physician Assistant
200 CENTRAL PARK S, SUITE 107
NEW YORK, NY 10019
New York County (212) 262-2500
DR. JEROME SAUL LUSTBADER D.M.D
Dentist
200 CENTRAL PARK S, SUITE 102
NEW YORK, NY 10019
New York County (212) 757-1370

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Michael Mistretta's NPI number?

The NPI number for Michael Mistretta is 1780602920. It was assigned to this individual provider in the NPPES registry on July 17, 2006.

Where is Michael Mistretta located?

Michael Mistretta practices at 200 Central Park S Suite 105, New York, NY 10019. The listed phone number is (212) 245-3292.

What is Michael Mistretta's specialty?

The primary specialty registered for this NPI is Oral & Maxillofacial Surgery with taxonomy code 204E00000X.

Is Michael Mistretta enrolled in Medicare?

No. Michael Mistretta has opted out of Medicare through May 30, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Michael Mistretta was last updated on April 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.