Richard A Shelestak, DMD
Individual provider Active NPI General Practice Dentistry · West Middlesex, PA
NPI 1043300593 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1043300593
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DS 021253-L (PA)
- Practice address
- 3115 Main St
West Middlesex, PA 16159 - Phone
- (724) 528-1515
- NPI assigned
- Oct 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151014001257 | PA | Order and Referring Only - Dentist |
2668781691 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS 021253-L | PA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DS 021253-L | PA | Yes |
Addresses
Primary practice location
3115 Main St
West Middlesex, PA 16159
Mailing address
3115 Main St
P O Box 252
West Middlesex, PA 16159
Phone (724) 528-1515
Other providers in West Middlesex, PA
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- Aaron Listopad
- Hopeanne Lovrinoff-Moran
- Deborah Jean Marcucci
- Michael Richard Shelestak
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- Nicole Shingledecker
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All providers in West Middlesex, PA · General Practice Dentistry in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.