Healthcare Provider Details

I. General information

NPI: 1750558995
Provider Name (Legal Business Name): AESTHETIC DENTAL CENTER OF FINLEYVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6108 BROWNSVILLE ROAD EXT SUITE 206
FINLEYVILLE PA
15332-4132
US

IV. Provider business mailing address

6108 BROWNSVILLE ROAD EXT SUITE 206
FINLEYVILLE PA
15332-4132
US

V. Phone/Fax

Practice location:
  • Phone: 724-348-4777
  • Fax: 724-348-7524
Mailing address:
  • Phone: 724-348-4777
  • Fax: 724-348-7524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS025257L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS026573L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS026782L
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS026411L
License Number StatePA

VIII. Authorized Official

Name: DR. MARK R. RABATIN
Title or Position: PRESIDENT
Credential:
Phone: 724-348-4777