NPIMap

Organization Active NPI

Nepa Dental Group - Wilkes Barre

  • General Practice Dentistry
  • Wilkes Barre, PA
National Provider Identifier
1124477880
Registry record updated Jun 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
NEPA DENTAL GROUP - WILKES BARRE
Practice address
213 E Market St
Wilkes Barre, PA 18702-5234
Phone
(570) 825-9645
NPI assigned
Jun 3, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2016

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

Authorized official

Name
Dr. John Costello, DMD
Title
Vice President
Phone
(570) 401-1783

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

213 E Market St
Wilkes Barre, PA 18702-5234

Mailing address

457 N Main St
Suite 100
Pittston, PA 18640-2183

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1464912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464912000000",
    "number": "1124477880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "457 N MAIN ST",
            "address_2": "SUITE 100",
            "city": "PITTSTON",
            "state": "PA",
            "postal_code": "186402183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 E MARKET ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187025234",
            "telephone_number": "570-825-9645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEPA DENTAL GROUP - WILKES BARRE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-03",
        "last_updated": "2016-06-03",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "570-401-1783",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.