Healthcare Provider Details

I. General information

NPI: 1801877006
Provider Name (Legal Business Name): ROBERT W QUEALE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 N MAPLE AVE
GREENSBURG PA
15601-2503
US

IV. Provider business mailing address

31 N MAPLE AVE
GREENSBURG PA
15601-2503
US

V. Phone/Fax

Practice location:
  • Phone: 724-837-7770
  • Fax: 724-838-7731
Mailing address:
  • Phone: 724-837-7770
  • Fax: 724-838-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDS026911L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: