Candice Nicole Ghazzouli, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS037471 Issued in PA

Practice address

1660 Sycamore Rd
Suite a
Montoursville, PA 17754-9314

Phone

(570) 323-4819

Fax

(570) 323-7057

NPI assigned

Feb 22, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Candice Nicole Carpenter Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 21, 2021 through Jan 21, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kop Dental Care

  • General Practice Dentistry
  • King of Prussia, PA
  • NPI 1730735283
  NPD (past)

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

{
    "created_epoch": "1298332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298332800000",
    "number": "1245537604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 SYCAMORE RD",
            "address_2": "SUITE A",
            "city": "MONTOURSVILLE",
            "state": "PA",
            "postal_code": "177549314",
            "telephone_number": "570-323-4819",
            "fax_number": "570-323-7057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 SYCAMORE RD",
            "address_2": "SUITE A",
            "city": "MONTOURSVILLE",
            "state": "PA",
            "postal_code": "177549314",
            "telephone_number": "570-323-4819",
            "fax_number": "570-323-7057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHAZZOULI",
        "first_name": "CANDICE",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-22",
        "last_updated": "2011-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS037471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CANDICE",
            "last_name": "CARPENTER",
            "middle_name": "NICOLE",
            "prefix": "DR.",
            "credential": "DMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Geisinger-HM Joint Venture, LLC
• Geisinger-HM Joint Venture, LLC
• Geisinger-HM Joint Venture, LLC
• Gerald D Rhodes DC PC
• Joel T Getty, OD
• Dominique L Gillespie, PT, DPT
• Lee Ann Grassmueck
• Gregg F Rhodes DC PC
• Namita Gupta, MD
• H2 Rehabilitation Extension Services, LLC

• General Practice Dentistry in Montoursville, PA
• Providers in Montoursville, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.