Active NPI
Robert L Kilareski, DDS
- Pediatric Dentistry
- Port Matilda, PA
National Provider Identifier
1578786273
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DS-031216-L
- Practice address
- 1019 Ghaner Rd Ste a
Port Matilda, PA 16870-7201 - Phone
- (814) 238-7120
- Fax
- (814) 238-2981
- NPI assigned
- Apr 11, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DS-031216-L | PA | Primary |
Addresses
Primary practice location
1019 Ghaner Rd Ste a
Port Matilda, PA 16870-7201
Mailing address
1019 Ghaner Rd Ste a
Port Matilda, PA 16870-7201
Phone (814) 238-7120
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0018041150002 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS-031216-L | PA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402876800000",
"number": "1578786273",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1019 GHANER RD STE A",
"city": "PORT MATILDA",
"state": "PA",
"postal_code": "168707201",
"telephone_number": "814-238-7120",
"fax_number": "814-238-2981"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1019 GHANER RD STE A",
"city": "PORT MATILDA",
"state": "PA",
"postal_code": "168707201",
"telephone_number": "814-238-7120",
"fax_number": "814-238-2981"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KILARESKI",
"first_name": "ROBERT",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-11",
"last_updated": "2014-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "PA",
"license": "DS-031216-L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0018041150002",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Matilda, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.