Ryan Carl Dell'Aglio, D.M.D – Dentist in Scranton, PA

Key facts

NPI: 1699110775
Entity type: Individual (NPI type 1)
Primary specialty: Dentist 122300000X
License: DS039531 (PA)
Practice address: 959 Wyoming Ave
Scranton Primary Health Center
Scranton, PA 18509-3023
Phone: (570) 504-0882
Fax: (570) 504-0859
NPI assigned: May 2, 2013
Sex: Male
Sole proprietor: No

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Scranton Primary Health Care Center, Inc. Federally Qualified Health Center (FQHC) · Scranton, PA · NPI 1801871579

Medicare reassignment NPD PA
Scranton Primary Health Care Center, Inc Federally Qualified Health Center (FQHC) · Scranton, PA · NPI 1841709623

NPD
Scranton Primary Health Care Center, Inc. Federally Qualified Health Center (FQHC) · Scranton, PA · NPI 1801336458

NPD

Medicare participation

Medicare fee-for-service enrollment: Enrolled in PA
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20170608000342	PA	Practitioner - Oral Surgery	0941503627	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
2013018051	MO	MD	Dentist
DS039531	PA	MD	Dentist

Practice roles

Organization	Status	New patients
Scranton Primary Health Care Center, Inc.	Current	Accepting new patients
Scranton Primary Health Care Center, Inc.	Current since Feb 8, 2017	Accepting new patients
Scranton Primary Health Care Center, Inc	Current since Feb 8, 2017	Accepting new patients

Locations

959 Wyoming Ave
Scranton, PA 18509
Phone (570) 344-3517

Interoperability endpoints

FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dentist	122300000X	2013018051	MO
Dentist	122300000X	DS039531	PA	Yes

Addresses

Primary practice location

959 Wyoming Ave
Scranton Primary Health Center
Scranton, PA 18509-3023

Mailing address

959 Wyoming Ave
Scranton Primary Health Care Center, Inc.
Scranton, PA 18509-3023
Phone (570) 504-0882

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 4, 2016.

{
    "created_epoch": "1367452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470268800000",
    "number": "1699110775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "959 WYOMING AVE",
            "address_2": "SCRANTON PRIMARY HEALTH CARE CENTER, INC.",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185093023",
            "telephone_number": "570-504-0882",
            "fax_number": "570-504-0859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "959 WYOMING AVE",
            "address_2": "SCRANTON PRIMARY HEALTH CENTER",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185093023",
            "telephone_number": "570-504-0882",
            "fax_number": "570-504-0859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELL'AGLIO",
        "first_name": "RYAN",
        "middle_name": "CARL",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-02",
        "last_updated": "2016-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2013018051",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS039531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scranton, PA

All providers in Scranton, PA · Dentist in Pennsylvania

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 4, 2016. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.