NPIMap

Organization Active NPI

State College Orthodontics, P.C.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • State College, PA
National Provider Identifier
1538468475
Registry record updated Feb 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
DS035437 Issued in PA
Legal business name
STATE COLLEGE ORTHODONTICS, P.C.
Practice address
2565 Park Center Blvd
Suite 300
State College, PA 16801-3007
Phone
(814) 308-9504
Fax
(814) 954-7723
NPI assigned
Mar 17, 2011
Last updated
Feb 7, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2012

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

Authorized official

Name
Dr. Diane Marie Ray, D.M.D., M.S.NPI 1376722033
Title
President
Phone
(814) 308-9504

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X DS035437 PA Primary

Addresses

Primary practice location

2565 Park Center Blvd
Suite 300
State College, PA 16801-3007

Mailing address

2565 Park Center Blvd
Suite 300
State College, PA 16801-3007
Phone (814) 308-9504

National Provider Directory

National Provider Directory

Locations

2565 Park Center Blvd
Ste 300
State College, PA 16801
Phone (814) 308-9504

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1300320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328572800000",
    "number": "1538468475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2565 PARK CENTER BLVD",
            "address_2": "SUITE 300",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168013007",
            "telephone_number": "814-308-9504",
            "fax_number": "814-954-7723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2565 PARK CENTER BLVD",
            "address_2": "SUITE 300",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168013007",
            "telephone_number": "814-308-9504",
            "fax_number": "814-954-7723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE COLLEGE ORTHODONTICS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-17",
        "last_updated": "2012-02-07",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "814-308-9504",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D., M.S."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "PA",
            "license": "DS035437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2012; 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.