Healthcare Provider Details

I. General information

NPI: 1295097442
Provider Name (Legal Business Name): ROBERT A PETCASH DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2879 W HARDIES RD
GIBSONIA PA
15044-8203
US

IV. Provider business mailing address

2879 W HARDIES RD
GIBSONIA PA
15044-8203
US

V. Phone/Fax

Practice location:
  • Phone: 724-444-7770
  • Fax: 724-444-7676
Mailing address:
  • Phone: 724-444-7770
  • Fax: 724-444-7676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number027733
License Number StatePA

VIII. Authorized Official

Name: DR. ROBERT A PETCASH
Title or Position: CEO
Credential: DMD
Phone: 724-444-7770