Individual provider Active NPI

Andrew Dillner, D.M.D.

  • General Practice Dentistry
  • Erie, PA
National Provider Identifier
1497161400
Registry record updated Jun 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS039975 Issued in PA
Practice address
702 W 34TH St
Erie, PA 16508
Phone
(814) 868-5411
Fax
(814) 866-2105
NPI assigned
Jul 10, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DS039975 PA Primary

Addresses

Primary practice location

702 W 34TH St
Erie, PA 16508

Mailing address

702 W 34TH St
Erie, PA 16508-2649
Phone (814) 868-5411

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20180103000044 PA Order and Referring Only - DentistPractitioner - Dentist 5698033215

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DS039975PAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1404950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528761600000",
    "number": "1497161400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 W 34TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165082649",
            "telephone_number": "814-868-5411",
            "fax_number": "814-866-2105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 W 34TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "16508",
            "telephone_number": "814-868-5411",
            "fax_number": "814-866-2105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DILLNER",
        "first_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-10",
        "last_updated": "2018-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS039975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.