Healthcare Provider Details

I. General information

NPI: 1639299548
Provider Name (Legal Business Name): WCP CLEMENZA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3041 INNOVATION WAY
HERMITAGE PA
16148-7905
US

IV. Provider business mailing address

3041 INNOVATION WAY
HERMITAGE PA
16148-7905
US

V. Phone/Fax

Practice location:
  • Phone: 724-981-8884
  • Fax: 724-981-7799
Mailing address:
  • Phone: 724-981-8884
  • Fax: 724-981-7799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VASSIE CLEMENZA
Title or Position: MEMBER
Credential: ESQ.
Phone: 724-981-8884