Mill Creek Dental, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

DS031640L Issued in PA

Legal business name

MILL CREEK DENTAL, LLC

Practice address

497 N Claude a Lord Blvd
Pottsville, PA 17901-2705

Phone

(570) 516-9109

Fax

(570) 516-9138

NPI assigned

Jul 16, 2013

Organization subpart

No

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

Authorized official

Name

David Pelagio, DMD

Title

Dentist

Phone

(570) 516-9109

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1373932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373932800000",
    "number": "1134560394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "497 N CLAUDE A LORD BLVD",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179012705",
            "telephone_number": "570-516-9109",
            "fax_number": "570-516-9138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "497 N CLAUDE A LORD BLVD",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179012705",
            "telephone_number": "570-516-9109",
            "fax_number": "570-516-9138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILL CREEK DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-16",
        "last_updated": "2013-07-16",
        "status": "A",
        "authorized_official_last_name": "PELAGIO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "570-516-9109",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS031640L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018499770003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nick Gerard Michels, H.I.S.
• Erica Miele, AU.D.
• Carol Ann Miller-Schaeffer, MD
• Kara Fisher Miller, D.O.
• Patricia Miller
• Matthew Mills, PA-C
• Cathy Miorelli, RN

• Dentist in Pottsville, PA
• Providers in Pottsville, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2013; 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.