Organization Active NPI

Pediatric Center of Canton, LLC

  • Pediatrics Physician
  • Canton, OH
National Provider Identifier
1194037150
Registry record updated Jul 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
34.008837 Issued in OH
Legal business name
PEDIATRIC CENTER OF CANTON, LLC
Practice address
4048 Dressler Rd NW Ste 203
Canton, OH 44718-2784
Phone
(330) 456-9939
Fax
(330) 456-3212
NPI assigned
Jul 7, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2025

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

Authorized official

Name
Julia Banta
Title
Om/Cma
Phone
(330) 456-9939

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X 35.047428 OH
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X 34.008837 OH Primary

Addresses

Primary practice location

4048 Dressler Rd NW Ste 203
Canton, OH 44718-2784

Mailing address

4048 Dressler Rd NW Ste 203
Canton, OH 44718-2784
Phone (330) 456-9939

Other practice location 1

1445 Harrison Ave. NW
Suite 300 & 306
Canton, OH 44708
Phone (330) 456-9939

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D1069123Pediatric Center of Canton LLC4048 Dressler Road NW, Suite 203, Canton, OH 44718Certificate of waiverMay 29, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1278460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753142400000",
    "number": "1194037150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4048 DRESSLER RD NW STE 203",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182784",
            "telephone_number": "330-456-9939",
            "fax_number": "330-456-3212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4048 DRESSLER RD NW STE 203",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182784",
            "telephone_number": "330-456-9939",
            "fax_number": "330-456-3212"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1445 Harrison Ave. NW",
            "address_2": "Suite 300 & 306",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "OH",
            "postal_code": "44708",
            "country_code": "US",
            "telephone_number": "330-456-9939",
            "fax_number": "330-456-3212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEDIATRIC CENTER OF CANTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-07",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A",
        "authorized_official_last_name": "BANTA",
        "authorized_official_first_name": "JULIA",
        "authorized_official_title_or_position": "OM/CMA",
        "authorized_official_telephone_number": "330-456-9939"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35.047428",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "34.008837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.