Carl Edward Baccellieri II, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DS030182L Issued in PA

Practice address

630 Cope Rd
Kennett Square, PA 19348-2438

Phone

(610) 444-0208

Fax

(610) 444-0653

NPI assigned

Jan 17, 2012

Last updated

Jan 17, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326758400000",
    "number": "1396016747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 COPE RD",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193482438",
            "telephone_number": "610-444-0208",
            "fax_number": "610-444-0653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 COPE RD",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193482438",
            "telephone_number": "610-444-0208",
            "fax_number": "610-444-0653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACCELLIERI",
        "first_name": "CARL",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-01-17",
        "last_updated": "2012-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS030182L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Baccellieri Family Dentistry LLP
• Carl Jackson Baccellieri, DC
• Samuel Bak, OTR/L
• Mark J Barimani, PAC
• Barry Kanofsky OD PA
• Paula Sorokanich Barry, MD

• Dentist in Kennett Square, PA
• Providers in Kennett Square, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 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.

Verify at the official NPI Registry.