Healthcare Provider Details

I. General information

NPI: 1992700744
Provider Name (Legal Business Name): DENTISTRY FOR CHILDREN AND TEENS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 3RD ST
BEAVER PA
15009-2350
US

IV. Provider business mailing address

PO BOX 537
BEAVER PA
15009-0537
US

V. Phone/Fax

Practice location:
  • Phone: 724-774-1920
  • Fax: 724-774-3332
Mailing address:
  • Phone: 724-774-1920
  • Fax: 724-774-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StatePA

VIII. Authorized Official

Name: DR. ROBERT ALAN DAVIS
Title or Position: DENTIST
Credential: D.M.D.
Phone: 724-774-1920