MEDICARE: SOUTH HILLS DENTAL ARTS - INGRAM, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1477869675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH HILLS DENTAL ARTS - INGRAM, LLC

Provider Business Mailing Address
First Line	:	2725 CENTER ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15205-2329
Country	:	US
Telephone Number	:	412-922-9292
Fax Number	:

Provider Business Practice Location Address
First Line	:	2725 CENTER ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15205-2329
Country	:	US
Telephone Number	:	412-922-9292
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	CURTIS STEVEN CRANDALL
Credential	:
Telephone Number	:	412-334-3713

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	11/18/2016

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