NPIMap

Organization Active NPI

Pediatric Dental Care PC, Inc

  • Pediatric Dentistry
  • Port Matilda, PA
National Provider Identifier
1972673010
Registry record updated Feb 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DS-031216-L Issued in PA
Legal business name
PEDIATRIC DENTAL CARE PC, INC
Practice address
1019 Ghaner Rd Ste 100
Port Matilda, PA 16870-7201
Phone
(814) 238-7120
Fax
(814) 238-2981
NPI assigned
Nov 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2016

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

Authorized official

Name
Dr. Robert L Kilareski, DDS
Title
Dentist
Phone
(814) 238-7120

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X DS-031216-L PA Primary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X DS-019843-L PA
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X DS-036188-L PA

Addresses

Primary practice location

1019 Ghaner Rd Ste 100
Port Matilda, PA 16870-7201

Mailing address

1019 Ghaner Rd Ste 100
Port Matilda, PA 16870-7201
Phone (814) 238-7120

Other identifiers 1

IdentifierTypeStateIssuer
1015435680001MedicaidPA

National Provider Directory

National Provider Directory

Locations

1019 Ghaner Rd
Ste 100
Port Matilda, PA 16870
Phone (814) 238-7120

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455494400000",
    "number": "1972673010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 GHANER RD STE 100",
            "city": "PORT MATILDA",
            "state": "PA",
            "postal_code": "168707201",
            "telephone_number": "814-238-7120",
            "fax_number": "814-238-2981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019 GHANER RD STE 100",
            "city": "PORT MATILDA",
            "state": "PA",
            "postal_code": "168707201",
            "telephone_number": "814-238-7120",
            "fax_number": "814-238-2981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL CARE PC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2016-02-15",
        "status": "A",
        "authorized_official_last_name": "KILARESKI",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "814-238-7120",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "PA",
            "license": "DS-031216-L",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "PA",
            "license": "DS-019843-L",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "PA",
            "license": "DS-036188-L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1015435680001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Matilda, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.