Healthcare Provider Details

I. General information

NPI: 1194911842
Provider Name (Legal Business Name): ATCHESON ORAL SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 09/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 3RD ST
BEAVER PA
15009-2350
US

IV. Provider business mailing address

255 3RD ST
BEAVER PA
15009-2350
US

V. Phone/Fax

Practice location:
  • Phone: 724-728-1700
  • Fax: 724-728-1413
Mailing address:
  • Phone: 724-728-1700
  • Fax: 724-728-1413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS-017928-L
License Number StatePA

VIII. Authorized Official

Name: DR. IRA DAVID ATCHESON
Title or Position: PRESIDENT
Credential: DMD
Phone: 724-728-1700