NPIMap

Organization Active NPI

Schuylkill Mall Dental

  • General Practice Dentistry
  • Frackville, PA
National Provider Identifier
1396969093
Registry record updated Jun 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS024286L Issued in PA
Legal business name
SCHUYLKILL MALL DENTAL
Practice address
Schuylkill Mall Dental
Route 61 at Interstate 81
Frackville, PA 18219
Phone
(570) 874-3714
Fax
(570) 874-3444
NPI assigned
Apr 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2008

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

Authorized official

Name
Dr. Raymond Edward Hische, DMD
Title
Owner
Phone
(570) 874-3714

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X DS024286L PA Primary

Addresses

Primary practice location

Schuylkill Mall Dental
Route 61 at Interstate 81
Frackville, PA 18219

Mailing address

Schuylkill Mall Dental
Route 61 at Interstate 81
Frackville, PA 18219
Phone (570) 874-3714

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213920000000",
    "number": "1396969093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "SCHUYLKILL MALL DENTAL",
            "address_2": "ROUTE 61 AT INTERSTATE 81",
            "city": "FRACKVILLE",
            "state": "PA",
            "postal_code": "18219",
            "telephone_number": "570-874-3714",
            "fax_number": "570-874-3444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SCHUYLKILL MALL DENTAL",
            "address_2": "ROUTE 61 AT INTERSTATE 81",
            "city": "FRACKVILLE",
            "state": "PA",
            "postal_code": "18219",
            "telephone_number": "570-874-3714",
            "fax_number": "570-874-3444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCHUYLKILL MALL DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2008-06-20",
        "status": "A",
        "authorized_official_last_name": "HISCHE",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-874-3714",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS024286L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frackville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.