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MRS. FELICITAS I WIBOWO DMD
NPI 1992972095
Dentist - Endodontics in Hanover, PA

Active since May 08, 2008Opted out of Medicare · through May 11, 2027
138 BROADWAY, HANOVER, PA 17331(717) 632-8571(717) 632-6466 Get Directions Write a Review

NPPES record last updated: March 15, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mrs. Felicitas I Wibowo Dmd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. FELICITAS I WIBOWO DMD (NPI 1992972095) is an individual endodontics provider in Hanover, Pennsylvania, licensed in Pennsylvania (DS037130) and active in the NPI registry since May 2008. She has opted out of Medicare through May 11, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1992972095
Entity TypeIndividualFemale
Primary Taxonomy1223E0200X
Provider Legal NameMRS. FELICITAS I WIBOWOCredential: DMD
Location Address138 BROADWAYHanover, PA 17331-2500
Mailing Address138 BroadwayHanover, PA 17331-2500 · (717) 632-8571 · Fax (717) 632-6466
Phone(717) 632-8571
Fax(717) 632-6466
Sole ProprietorYes
Enumeration DateMay 8, 2008
Last NPPES UpdateMarch 15, 2023
NPPES CertifiedMarch 15, 2023
✔ NPI 1992972095 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · EndodonticsDental Providers
Taxonomy Code1223E0200X
License✔ Licensed in PA · DS037130
Definition
The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions.
138 BROADWAY, Hanover, PA 17331
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Mrs. Felicitas I Wibowo Dmd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from May 11, 2015 through May 11, 2027.

Opt-Out Effective DateMay 11, 2015
Opt-Out In Effect ThroughMay 11, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 17331 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.88 typical visit price
range $54.64 – $166.87
Typical copayment $21.22 (range $13.66 – $41.71)
Most-billed visit code 99203
Established Patient
$68.36 typical visit price
range $17.33 – $135.84
Typical copayment $17.09 (range $4.33 – $33.96)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JON EUGENE HART I D.M.D.
Dentist (General Practice)
138 BROADWAY
HANOVER, PA 17331
York County (717) 632-8571
MR. OMEIR MALLICK DDS
Dentist
138 BROADWAY
HANOVER, PA 17331
York County (717) 632-8571

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Felicitas Wibowo's NPI number?

The NPI number for Felicitas Wibowo is 1992972095. It was assigned to this individual provider in the NPPES registry on May 8, 2008.

Where is Felicitas Wibowo located?

Felicitas Wibowo practices at 138 Broadway, Hanover, PA 17331. The listed phone number is (717) 632-8571.

What is Felicitas Wibowo's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Endodontics, with taxonomy code 1223E0200X.

Is Felicitas Wibowo enrolled in Medicare?

No. Felicitas Wibowo has opted out of Medicare through May 11, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

What insurance does Felicitas Wibowo accept?

Health plans from Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 5 other insurers list Felicitas Wibowo as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Felicitas Wibowo was last updated on March 15, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.