Healthcare Provider Details

I. General information

NPI: 1851729123
Provider Name (Legal Business Name): ASSOCIATED DENTAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 STEUBENVILLE PIKE SUITE 110
MC KEES ROCKS PA
15136-1344
US

IV. Provider business mailing address

6201 STEUBENVILLE PIKE SUITE 110
MC KEES ROCKS PA
15136-1344
US

V. Phone/Fax

Practice location:
  • Phone: 412-722-1991
  • Fax:
Mailing address:
  • Phone: 412-722-1991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. JOHN G HISCHAR
Title or Position: BUSINESS MANAGER
Credential:
Phone: 412-722-1991