Healthcare Provider Details

I. General information

NPI: 1205546496
Provider Name (Legal Business Name): ADVANCED DENTAL SPECIALTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CORPORATE CENTER DR
CORAOPOLIS PA
15108-4331
US

IV. Provider business mailing address

100 CORPORATE CENTER DR
CORAOPOLIS PA
15108-4331
US

V. Phone/Fax

Practice location:
  • Phone: 412-262-1001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DONALD CHAPMAN
Title or Position: OWNER
Credential: DDS
Phone: 304-312-4884