Anthony M Pedicino, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

023689 Issued in PA

Practice address

1916 Welsh Rd
Suite 1B
Philadelphia, PA 19115-4655

Phone

(215) 464-6663

Fax

(215) 464-4949

NPI assigned

May 14, 2013

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.

• Anthony M. Pedicino,DDS.,PC.

  • General Practice Dentistry
  • Philadelphia, PA
  • NPI 1073646600
  NPD (past) Authorized official

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

{
    "created_epoch": "1368489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368489600000",
    "number": "1508202862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1916 WELSH RD",
            "address_2": "SUITE 1B",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191154655",
            "telephone_number": "215-464-6663",
            "fax_number": "215-464-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1916 WELSH RD",
            "address_2": "SUITE 1B",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191154655",
            "telephone_number": "215-464-6663",
            "fax_number": "215-464-4949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDICINO",
        "first_name": "ANTHONY",
        "middle_name": "M",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-05-14",
        "last_updated": "2013-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "023689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pediatric Dental Associates LTD
• Pediatric Dental Associates, LTD
• Pediatric Dental Team
• Pediatric Orthotic and Prosthetic Services- Northeast, LLC
• Pediatric Pulmonary Associates P.a.
• Terrence J Pedrotty, C.R.N.A.
• Mauricio A Pedroza, MD
• Rebecka Peebles, MD
• Alexis Rachel Peedin, MD
• Peekaboo Pediatrics

• Dentist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2013; 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.