Healthcare Provider Details

I. General information

NPI: 1316403454
Provider Name (Legal Business Name): PENN DENTAL SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 WASHINGTON RD STE 303
MC MURRAY PA
15317-3279
US

IV. Provider business mailing address

3055 WASHINGTON RD STE 303
MC MURRAY PA
15317-3279
US

V. Phone/Fax

Practice location:
  • Phone: 724-942-5630
  • Fax: 724-942-5632
Mailing address:
  • Phone: 724-942-5630
  • Fax: 724-942-5632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
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. EDWARD BIENVENIDO MINAYA
Title or Position: OWNER
Credential:
Phone: 814-232-7985