NPIMap

Organization Active NPI

Lake Erie Dental Inc

  • General Practice Dentistry
  • Edinboro, PA
National Provider Identifier
1568629335
Registry record updated May 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
017224 Issued in PA
Legal business name
LAKE ERIE DENTAL INC
Practice address
106 Waterford Street
Edinboro, PA 16412
Phone
(814) 734-1814
Fax
(814) 734-7163
NPI assigned
May 20, 2008
Last updated
May 20, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
LAKE ERIE DENTAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 20, 2008

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

Authorized official

Name
Dr. Kevin Sambuchino, DMD
Title
President
Phone
(814) 734-1814

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 031305 PA
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 017224 PA Primary

Addresses

Primary practice location

106 Waterford Street
Edinboro, PA 16412

Mailing address

106 Waterford Street
PO Box 391
Edinboro, PA 16412
Phone (814) 734-1814

National Provider Directory

National Provider Directory
Tax ID family
Lake Erie Dental Inc2 organizations share this tax ID, including this one
Part of
Lake Erie Dental Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

106 Waterford St
Edinboro, PA 16412
Phone (814) 730-2666

NPI Registry JSON

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

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211241600000",
    "number": "1568629335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 WATERFORD STREET",
            "address_2": "PO BOX 391",
            "city": "EDINBORO",
            "state": "PA",
            "postal_code": "16412",
            "telephone_number": "814-734-1814",
            "fax_number": "814-734-7163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 WATERFORD STREET",
            "city": "EDINBORO",
            "state": "PA",
            "postal_code": "16412",
            "telephone_number": "814-734-1814",
            "fax_number": "814-734-7163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE ERIE DENTAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKE ERIE DENTAL INC",
        "enumeration_date": "2008-05-20",
        "last_updated": "2008-05-20",
        "status": "A",
        "authorized_official_last_name": "SAMBUCHINO",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "814-734-1814",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "031305",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "017224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edinboro, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; 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.