Konstantine Pantelides, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30-01-5892 Issued in OH

Practice address

505 S Union Ave
Alliance, OH 44601-2928

Phone

(330) 821-0145

Fax

(330) 821-6019

NPI assigned

Jun 16, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198195200000",
    "number": "1538164405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 S UNION AVE",
            "city": "ALLIANCE",
            "state": "OH",
            "postal_code": "446012928",
            "telephone_number": "330-821-0145",
            "fax_number": "330-821-6019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 S UNION AVE",
            "city": "ALLIANCE",
            "state": "OH",
            "postal_code": "446012928",
            "telephone_number": "330-821-0145",
            "fax_number": "330-821-6019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANTELIDES",
        "first_name": "KONSTANTINE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2007-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30-01-5892",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "28604",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2161057",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DORAL DENTAL",
            "identifier": "9180702",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashton Taylor Owens, APRN
• Latisha Padgett-Craine
• Eric R Paliswat, APRN
• Carl Rocco Palladino, PHARM.D.
• Roger S Palutsis, M.D.
• Diane S Papadeonise, NP
• Paragon Heart Group, Inc
• Breanna Paravano
• Michelle L Parella, CRNA
• Veedhiben Jaykumar Patel

• General Practice Dentistry in Alliance, OH
• Providers in Alliance, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2007; 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.