Kevin R Sambuchino, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

031305 Issued in PA

Practice address

4944 Peach St
Erie, PA 16509-2012

Phone

(814) 864-7511

Fax

(814) 866-1565

NPI assigned

May 3, 2007

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

Practice roles

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

• Lake Erie Dental, Inc.

  • General Practice Dentistry
  • Erie, PA
  • NPI 1275700577
  NPD (past) Authorized official

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771891200000",
    "number": "1497977037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4944 PEACH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092012",
            "telephone_number": "814-864-7511",
            "fax_number": "814-866-1565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4944 PEACH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092012",
            "telephone_number": "814-864-7511",
            "fax_number": "814-866-1565"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4820 Buffalo Rd",
            "address_purpose": "LOCATION",
            "city": "Erie",
            "state": "PA",
            "postal_code": "165102302",
            "country_code": "US",
            "telephone_number": "410-899-0444",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3419 State St",
            "address_purpose": "LOCATION",
            "city": "Erie",
            "state": "PA",
            "postal_code": "165082831",
            "country_code": "US",
            "telephone_number": "410-456-7821",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMBUCHINO",
        "first_name": "KEVIN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2026-02-24",
        "certification_date": "2026-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "031305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brett Saltrick, DPM
• Patricia Dizon Salvador, M.D.
• Daniel Alvarez Salvatierra, DO
• Michael R Salvatore, MD
• Sam'S Club Optical
• Farhad Ahmed Sami, M.B.B.S
• Trevor Andrew Samol, CRNP
• Jennifer Samosky, DPT
• Courtney A.R. Sampson, D.O.
• Lauren Sampson

• General Practice Dentistry in Erie, PA
• Providers in Erie, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2026; 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.