Active NPI
Felicitas I Wibowo, DMD
- Endodontics
- Hanover, PA
National Provider Identifier
1992972095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- DS037130
- Practice address
- 138 Broadway
Hanover, PA 17331-2500 - Phone
- (717) 632-8571
- Fax
- (717) 632-6466
- NPI assigned
- May 8, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | DS037130 | PA | Primary |
Addresses
Primary practice location
138 Broadway
Hanover, PA 17331-2500
Mailing address
138 Broadway
Hanover, PA 17331-2500
Phone (717) 632-8571
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective May 11, 2015 through May 11, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS037130 | PA | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| York Endodontics, PC | Endodontics | 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.
-
- Endodontics
- York, PA
- NPI 1578783320
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678838400000",
"number": "1992972095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "138 BROADWAY",
"city": "HANOVER",
"state": "PA",
"postal_code": "173312500",
"telephone_number": "717-632-8571",
"fax_number": "717-632-6466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "138 BROADWAY",
"city": "HANOVER",
"state": "PA",
"postal_code": "173312500",
"telephone_number": "717-632-8571",
"fax_number": "717-632-6466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIBOWO",
"first_name": "FELICITAS",
"middle_name": "I",
"name_prefix": "Mrs.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-08",
"last_updated": "2023-03-15",
"certification_date": "2023-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "PA",
"license": "DS037130",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hanover, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2023; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.