John Edward Miceli, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS-030548-L Issued in PA

Practice address

9984 Martin Ave
Lake City, PA 16423-1527

Phone

(814) 774-5242

Fax

(814) 774-5242

NPI assigned

Oct 31, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• West Ridge Family Dental, P.C.

  • General Practice Dentistry
  • Erie, PA
  • NPI 1013189349
  NPD (past)

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1982780862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "944 AURORA AVE",
            "city": "GIRARD",
            "state": "PA",
            "postal_code": "164171246",
            "telephone_number": "814-774-1498",
            "fax_number": "814-774-5242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9984 MARTIN AVE",
            "city": "LAKE CITY",
            "state": "PA",
            "postal_code": "164231527",
            "telephone_number": "814-774-5242",
            "fax_number": "814-774-5242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICELI",
        "first_name": "JOHN",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS-030548-L",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "12971",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.021870",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Godoy, RD
• Erin Lynn Hoeksema, OTR/L
• William Howard Johnson, RN, CCRC
• Lake City Fire Company
• Amy McCall, MS OTR/L
• Jillian Marie Rhoades, LCSW
• Charles William Terpilowski III
• Renee Wahlenmayer, M.A., CCC-SLP

• General Practice Dentistry in Lake City, PA
• Providers in Lake City, PA by specialty
• General Practice Dentistry 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.