John P Konicki, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DS023443L Issued in PA

Practice address

278 Main Street
Suite 101
Dupont, PA 18641

Phone

(570) 655-8973

Fax

(570) 655-3588

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760592430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "278 MAIN STREET",
            "address_2": "SUITE 101",
            "city": "DUPONT",
            "state": "PA",
            "postal_code": "18641",
            "telephone_number": "570-655-8973",
            "fax_number": "570-655-3588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "278 MAIN STREET",
            "address_2": "SUITE 101",
            "city": "DUPONT",
            "state": "PA",
            "postal_code": "18641",
            "telephone_number": "570-655-8973",
            "fax_number": "570-655-3588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONICKI",
        "first_name": "JOHN",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS023443L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas F. Darbenzio, O.D.
• Nestor Garcia Dequevedo, D.C.
• Adam Christopher Hook
• Brian Shawn Jones, PT
• Brianna Ketcho, PTA
• Peter X Konicki, RPH
• Catherine M Madsen, RD
• Tracy Ann Mooney Wynder, RN
• Tyler James Motisko, DC
• Paul M Rutkowski DO PC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.