Healthcare Provider Details

I. General information

NPI: 1447874490
Provider Name (Legal Business Name): PEACE DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 S 2ND AVE
CLARION PA
16214-1934
US

IV. Provider business mailing address

1509 MOUNT ROYAL BLVD
GLENSHAW PA
15116-2207
US

V. Phone/Fax

Practice location:
  • Phone: 814-226-8690
  • Fax:
Mailing address:
  • Phone: 814-421-8727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: NICOLE L PEACE
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 412-874-9229