Paxtang Family Dentistry Inc

Primary specialty

DentistTaxonomy code 122300000X

License

DS035741 Issued in PA

Legal business name

PAXTANG FAMILY DENTISTRY INC

Practice address

3404 Derry St
Suite 1
Harrisburg, PA 17111-1834

Phone

(717) 561-1209

Fax

(717) 561-4033

NPI assigned

Nov 30, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Jill Rachael Carre, DMD

Title

Owner

Phone

(717) 561-1209

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1322611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322611200000",
    "number": "1639446057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3404 DERRY ST",
            "address_2": "SUITE 1",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171111834",
            "telephone_number": "717-561-1209",
            "fax_number": "717-561-4033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3404 DERRY ST",
            "address_2": "SUITE 1",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171111834",
            "telephone_number": "717-561-1209",
            "fax_number": "717-561-4033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAXTANG FAMILY DENTISTRY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-30",
        "last_updated": "2011-11-30",
        "status": "A",
        "authorized_official_last_name": "CARRE",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "RACHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "717-561-1209",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS035741",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1024184100001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2011; 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.