NPIMap

Organization Active NPI

Pediatric Dental Care

  • Pediatric Dentistry
  • Wyomissing, PA
National Provider Identifier
1265730535
Registry record updated Mar 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DS035069 Issued in PA
Legal business name
PEDIATRIC DENTAL CARE
Practice address
344 N Wyomissing Blvd
Wyomissing, PA 19610-2936
Phone
(610) 375-3844
NPI assigned
Mar 10, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2011

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

Authorized official

Name
Dr. Preciosa Perez, DDSNPI 1922214709
Title
Owner
Phone
(610) 375-3844

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X DS031182L PA
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X DS035069 PA Primary

Addresses

Primary practice location

344 N Wyomissing Blvd
Wyomissing, PA 19610-2936

Mailing address

344 N Wyomissing Blvd
Wyomissing, PA 19610-2936
Phone (610) 375-3844

Other identifiers 2

IdentifierTypeStateIssuer
001781306-0009MedicaidPA
001883048-0002MedicaidPA

Other names 1

  • Pediatric Dental Care of Berks County Other name

National Provider Directory

National Provider Directory

Locations

344 N Wyomissing Blvd
Wyomissing, PA 19610
Phone (610) 375-3844

Practitioners & affiliated clinicians

Practitioners 1

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": "1299715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299715200000",
    "number": "1265730535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "344 N WYOMISSING BLVD",
            "city": "WYOMISSING",
            "state": "PA",
            "postal_code": "196102936",
            "telephone_number": "610-375-3844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "344 N WYOMISSING BLVD",
            "city": "WYOMISSING",
            "state": "PA",
            "postal_code": "196102936",
            "telephone_number": "610-375-3844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-10",
        "last_updated": "2011-03-10",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "PRECIOSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-375-3844",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS031182L",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "PA",
            "license": "DS035069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001781306-0009",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001883048-0002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Dental Care of Berks County",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wyomissing, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.