Gina Marie Rakosky Ober, DMD
Individual provider Active NPI General Practice Dentistry · California, PA
NPI 1760558282 · NPPES record last updated Jan 6, 2015
Key facts
- NPI
- 1760558282
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DS031328L (PA)
- Practice address
- 144 3Rd St
California, PA 15419-1130 - Phone
- (724) 938-7101
- Fax
- (724) 938-8467
- NPI assigned
- Nov 27, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151009000585 | PA | Order and Referring Only - Dentist |
0345558490 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS031328L | PA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DRS Belasco Ober & Associates PC | General Practice | Past | Accepting new patients |
Interoperability endpoints
- gina.rakoskyober.d1.p10@direct.360care.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DS031328L | PA | Yes |
Addresses
Primary practice location
144 3Rd St
California, PA 15419-1130
Mailing address
1108 Fayette Avenue
Belle Vernon, PA 15012
Phone (724) 929-3368
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10287498600001 | Medicaid | PA | |
| 529406 | Other | PA | UCCI |
Other names
- Dr. Gina Marie Pagac
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 6, 2015. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.