Active NPI
Phillip R Pate, DDS
- Pediatric Dentistry
- Kokomo, IN
National Provider Identifier
1780756122
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 6519
- Practice address
- 2705 S Berkley
Building 2 Suite B
Kokomo, IN 46902-8007 - Phone
- (765) 453-2267
- Fax
- (765) 453-1150
- NPI assigned
- Nov 14, 2006
- 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 | 6519 | IN | Primary |
Addresses
Primary practice location
2705 S Berkley
Building 2 Suite B
Kokomo, IN 46902-8007
Mailing address
2705 S Berkley
Building 2 Suite B
Kokomo, IN 46902-8007
Phone (765) 453-2267
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6519 | Other | IN | DENTAL LICENSE |
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 |
|---|---|---|---|
| 6519 | IN | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Dental Specialists of Indiana PC | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatric Dentistry
- Kokomo, IN
- NPI 1669582813
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780756122",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2705 S BERKLEY",
"address_2": "BUILDING 2 SUITE B",
"city": "KOKOMO",
"state": "IN",
"postal_code": "469028007",
"telephone_number": "765-453-2267",
"fax_number": "765-453-1150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2705 S BERKLEY",
"address_2": "BUILDING 2 SUITE B",
"city": "KOKOMO",
"state": "IN",
"postal_code": "469028007",
"telephone_number": "765-453-2267",
"fax_number": "765-453-1150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATE",
"first_name": "PHILLIP",
"middle_name": "R",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "IN",
"license": "6519",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE",
"identifier": "6519",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kokomo, IN
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.