Kanisha S. Campbell, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DS042573 Issued in PA

Practice address

3565 Route 611 FL 2
Bartonsville, PA 18321-7800

Phone

(570) 629-1142

NPI assigned

Jun 8, 2011

Last updated

Nov 18, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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 TX

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dr. Ross Wezmar DDS PC

  dba Smiles 4 Keeps Children's Dentistry

  • Dental Clinic/Center
  • Bartonsville, PA
  • NPI 1558604538
  NPD (past)
• S4K Bartonsville, LLC

  • Pediatric Dentistry
  • Bartonsville, PA
  • NPI 1356003891
  NPD (past)

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

{
    "created_epoch": "1307491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605657600000",
    "number": "1457645384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3565 ROUTE 611 FL 2",
            "city": "BARTONSVILLE",
            "state": "PA",
            "postal_code": "183217800",
            "telephone_number": "570-629-1142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3565 ROUTE 611 FL 2",
            "city": "BARTONSVILLE",
            "state": "PA",
            "postal_code": "183217800",
            "telephone_number": "570-629-1142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "KANISHA",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-08",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "PA",
            "license": "DS042573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bartonsville Family Dental PC
• Bayada Home Health Care, Inc.
• William Bozek, DMD
• Gary Eugene Burkhart, DMD
• Faith Burns
• Tanya Marie Cheeseman, DMD
• Chris Peechatka Corrective Chiropractic PC
• Charles FM Cohan, DO FACP
• Comprehensive Family Practice PC
• Dr. Ross Wezmar DDS PC (Smiles 4 Keeps Children's Dentistry)

• Pediatric Dentistry in Bartonsville, PA
• Providers in Bartonsville, PA by specialty
• Pediatric Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; 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.