NPIMap

Organization Active NPI

Lake Erie Dental, Inc.

  • General Practice Dentistry
  • Erie, PA
National Provider Identifier
1275700577
Registry record updated May 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
17224 Issued in PA
Legal business name
LAKE ERIE DENTAL, INC.
Practice address
4944 Peach St
Erie, PA 16509-2012
Phone
(814) 864-7511
Fax
(814) 866-1565
NPI assigned
May 15, 2008
Organization subpart
Yes
Parent organization
LAKE ERIE DENTAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 15, 2008

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

Authorized official

Name
Dr. Kevin Sambuchino, D.M.D.NPI 1497977037
Title
President
Phone
(814) 864-7511

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
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 031305 PA
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 17224 PA Primary

Addresses

Primary practice location

4944 Peach St
Erie, PA 16509-2012

Mailing address

4944 Peach St
Erie, PA 16509-2012
Phone (814) 864-7511

National Provider Directory

National Provider Directory
Tax ID family
Lake Erie Dental Inc2 organizations share this tax ID, including this one
Part of
Lake Erie Dental Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4944 Peach St
Erie, PA 16509
Phone (814) 864-7511

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": "1210809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210809600000",
    "number": "1275700577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4944 PEACH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092012",
            "telephone_number": "814-864-7511",
            "fax_number": "814-866-1565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4944 PEACH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092012",
            "telephone_number": "814-864-7511",
            "fax_number": "814-866-1565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE ERIE DENTAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKE ERIE DENTAL, INC.",
        "enumeration_date": "2008-05-15",
        "last_updated": "2008-05-15",
        "status": "A",
        "authorized_official_last_name": "SAMBUCHINO",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "814-864-7511",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "031305",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "17224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; 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.