Active NPI
Kelly Rachelle Zukaitis, DDS
- Pediatric Dentistry
- Gastonia, NC
National Provider Identifier
1255337150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 6708
- Practice address
- 991 W Hudson Blvd
Gastonia, NC 28052-6430 - Phone
- (704) 852-5294
- Fax
- (704) 853-5269
- NPI assigned
- Jun 24, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 6708 | NC | Primary |
Addresses
Primary practice location
991 W Hudson Blvd
Gastonia, NC 28052-6430
Mailing address
991 W Hudson Blvd
Gastonia, NC 28052-6430
Phone (704) 852-5294
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 90026 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150805006583 | NC | Order and Referring Only - Oral Surgery | 8820302839 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6708 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329868800000",
"number": "1255337150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "991 W HUDSON BLVD",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280526430",
"telephone_number": "704-852-5294",
"fax_number": "704-853-5269"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "991 W HUDSON BLVD",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280526430",
"telephone_number": "704-852-5294",
"fax_number": "704-853-5269"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZUKAITIS",
"first_name": "KELLY",
"middle_name": "RACHELLE",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-06-24",
"last_updated": "2012-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NC",
"license": "6708",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "90026",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gastonia, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.