Healthcare Provider Details

I. General information

NPI: 1750279253
Provider Name (Legal Business Name): RIDER GUSTAAF DAAS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 07/13/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DONOHOE RD
GREENSBURG PA
15601-6986
US

IV. Provider business mailing address

1821 EDWARDS WAY
PITTSBURGH PA
15203-1806
US

V. Phone/Fax

Practice location:
  • Phone: 724-836-1777
  • Fax:
Mailing address:
  • Phone: 732-216-7236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS045222
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: