Healthcare Provider Details

I. General information

NPI: 1750552519
Provider Name (Legal Business Name): NORTH POINTE DENTAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7031 CRIDER RD SUITE 200
MARS PA
16046-2385
US

IV. Provider business mailing address

7031 CRIDER RD SUITE 200
MARS PA
16046-2385
US

V. Phone/Fax

Practice location:
  • Phone: 724-772-2929
  • Fax: 724-772-2930
Mailing address:
  • Phone: 724-772-2929
  • Fax: 724-772-2930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS-027431-L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier902725
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUNITED CONCORDIA COMPANY

VIII. Authorized Official

Name: DR. BOBBIE LEE HAWRANKO
Title or Position: OWNER/PRESIDENT
Credential: DMD
Phone: 724-772-2929