Healthcare Provider Details

I. General information

NPI: 1770854549
Provider Name (Legal Business Name): PEACH STREET DENTAL & DENTURES, PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7040 PEACH ST
ERIE PA
16509
US

IV. Provider business mailing address

7040 PEACH ST
ERIE PA
16509
US

V. Phone/Fax

Practice location:
  • Phone: 814-866-7500
  • Fax: 814-866-7555
Mailing address:
  • Phone: 814-866-7500
  • Fax: 814-866-7555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code126900000X
TaxonomyDental Laboratory Technician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. AMAN U SYED
Title or Position: PRESIDENT
Credential:
Phone: 716-400-1868