Healthcare Provider Details

I. General information

NPI: 1104708940
Provider Name (Legal Business Name): PA DENTIST PARTNERS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1658 ROUTE 228 STE 300
CRANBERRY TOWNSHIP PA
16066-5342
US

IV. Provider business mailing address

111 E WACKER DR STE 2205
CHICAGO IL
60601-4600
US

V. Phone/Fax

Practice location:
  • Phone: 513-367-2999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
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: PAMELA BUSCEMI
Title or Position: VICE PRESIDENT
Credential:
Phone: 586-557-2748