Active NPI
Richard A Shelestak, DMD
- General Practice Dentistry
- West Middlesex, PA
National Provider Identifier
1043300593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DS 021253-L
- Practice address
- 3115 Main St
West Middlesex, PA 16159 - Phone
- (724) 528-1515
- NPI assigned
- Oct 13, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DS 021253-L | PA | Primary |
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
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151014001257 | PA | Order and Referring Only - Dentist | 2668781691 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS 021253-L | PA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043300593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3115 MAIN ST",
"address_2": "P O BOX 252",
"city": "WEST MIDDLESEX",
"state": "PA",
"postal_code": "16159",
"telephone_number": "724-528-1515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3115 MAIN ST",
"city": "WEST MIDDLESEX",
"state": "PA",
"postal_code": "16159",
"telephone_number": "724-528-1515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHELESTAK",
"first_name": "RICHARD",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "PA",
"license": "DS 021253-L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Middlesex, PA
- Jade George, M.S. CCC-SLP
- Aaron Listopad
- Hopeanne Lovrinoff-Moran, LMT
- Deborah Jean Marcucci, LCSW
- Michael Richard Shelestak, DMD
- Shenango TWP Vol Fire Dept Mercer Co PA (Shenango Twp Vol Fire Dept)
- Nicole Shingledecker, PHARM.D.
- Simply Science Nutrition Counseling LLC
- Upmc Community Medicine Inc (Horizon Family Medicine - UPMC - West Middlesex)
- Upmc Community Medicine Inc (Horizon Family Medicine-UPMC)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.