Active NPI
Peter M Pedalino, DDS
- General Practice Dentistry
- Elmendorf Afb, AK
National Provider Identifier
1265675573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 24432
- Practice address
- 5955 Zeamer Ave
Elmendorf Afb, AK 99506-3702 - Phone
- (907) 580-5010
- NPI assigned
- Apr 16, 2009
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 24432 | TX | Primary |
Addresses
Primary practice location
5955 Zeamer Ave
Elmendorf Afb, AK 99506-3702
Mailing address
2128 Franklin Dr
Papillion, NE 68133-2371
Phone (443) 534-2138
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24432 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671494400000",
"number": "1265675573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2128 FRANKLIN DR",
"city": "PAPILLION",
"state": "NE",
"postal_code": "681332371",
"telephone_number": "443-534-2138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5955 ZEAMER AVE",
"city": "ELMENDORF AFB",
"state": "AK",
"postal_code": "995063702",
"telephone_number": "907-580-5010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDALINO",
"first_name": "PETER",
"middle_name": "M",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-16",
"last_updated": "2022-12-20",
"certification_date": "2022-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "24432",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elmendorf Afb, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.