Individual provider Active NPI

Paul Alexander Pianovich, D.D.S.

  • General Practice Dentistry
  • Lykens, PA
National Provider Identifier
1811904410
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS024458L Issued in PA
Practice address
606 S 2ND St
Lykens, PA 17048-1547
Phone
(717) 453-7273
NPI assigned
Aug 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DS024458L PA Primary

Addresses

Primary practice location

606 S 2ND St
Lykens, PA 17048-1547

Mailing address

606 S 2ND St
Lykens, PA 17048-1547
Phone (717) 453-7273

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20150608000135 PA Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 0840511564

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DS024458LPAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811904410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 S 2ND ST",
            "city": "LYKENS",
            "state": "PA",
            "postal_code": "170481547",
            "telephone_number": "717-453-7273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 S 2ND ST",
            "city": "LYKENS",
            "state": "PA",
            "postal_code": "170481547",
            "telephone_number": "717-453-7273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PIANOVICH",
        "first_name": "PAUL",
        "middle_name": "ALEXANDER",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS024458L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lykens, PA

Sources for this page

Verify at the official NPI Registry.