Healthcare Provider Details

I. General information

NPI: 1841120607
Provider Name (Legal Business Name): KEYSPACE PEDIATRIC DENTAL STUDIO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3942 WILLIAM FLYNN HWY
ALLISON PARK PA
15101-3609
US

IV. Provider business mailing address

3942 WILLIAM FLYNN HWY
ALLISON PARK PA
15101-3609
US

V. Phone/Fax

Practice location:
  • Phone: 412-487-8423
  • Fax:
Mailing address:
  • Phone: 412-487-8423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHNNY WANA JOSEPH
Title or Position: OWNER
Credential: DMD
Phone: 857-200-3312