Douglas G Kistler, D.D.S.
Individual provider Active NPI General Practice Dentistry · Spring Grove, PA
NPI 1174636799 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1174636799
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DSO29459L (PA)
- Practice address
- 26 Roth Church Rd
Spring Grove Professional Center
Spring Grove, PA 17362-1406 - Phone
- (717) 225-5741
- NPI assigned
- Aug 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 1, 2012 through Jul 1, 2028
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DSO29459L | PA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Reigart-Kistler DDS, Inc. | General Practice | Past | Accepting new patients |
| Edp of Pennsylvania PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DSO29459L | PA | Yes |
Addresses
Primary practice location
26 Roth Church Rd
Spring Grove Professional Center
Spring Grove, PA 17362-1406
Mailing address
26 Roth Church Rd
Spring Grove Professional Center
Spring Grove, PA 17362-1406
Phone (717) 225-5741
Other providers in Spring Grove, PA
- Lindsay Marie Hodgson
- Christine D Holtz
- Divya Jalota
- Kristia Danielle Kannel
- Kennies Market Inc
- Diana May Kline
- LHM Physical Therapy Institute LLC
- Linda M Taylor MD LLC
- Brett Rambo Lloyd-Green
- Main Street Family Medicine of Spring Grove, Inc.
All providers in Spring Grove, 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).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.