Active NPI
Peter Dale Vansickels, D.D.S
- Dentist
- Exmore, VA
National Provider Identifier
1295848596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401005066
- Practice address
- 4208 Seaside Rd
Exmore, VA 23350-2575 - Phone
- (757) 442-5005
- Fax
- (757) 442-5005
- NPI assigned
- Aug 17, 2006
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 0401005066 | VA | Primary |
Addresses
Primary practice location
4208 Seaside Rd
Exmore, VA 23350-2575
Mailing address
4208 Seaside Rd
Exmore, VA 23350-2575
Phone (757) 442-5005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- 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 |
|---|---|---|---|---|
| I20160414001649 | VA | Order and Referring Only - Oral Surgery | 0446558027 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401005066 | VA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1253491200000",
"number": "1295848596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4208 SEASIDE RD",
"city": "EXMORE",
"state": "VA",
"postal_code": "233502575",
"telephone_number": "757-442-5005",
"fax_number": "757-442-5005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4208 SEASIDE RD",
"city": "EXMORE",
"state": "VA",
"postal_code": "233502575",
"telephone_number": "757-442-5005",
"fax_number": "757-442-5005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANSICKELS",
"first_name": "PETER",
"middle_name": "DALE",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-17",
"last_updated": "2009-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401005066",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Exmore, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2009; 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.