Healthcare Provider Details

I. General information

NPI: 1811106123
Provider Name (Legal Business Name): EDWIN EUGENE ASSID DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2867 WASHINGTON RD
MCMURRAY PA
15317
US

IV. Provider business mailing address

2867 WASHINGTON RD
MCMURRAY PA
15317
US

V. Phone/Fax

Practice location:
  • Phone: 724-941-9600
  • Fax: 724-941-7448
Mailing address:
  • Phone: 724-941-9600
  • Fax: 724-941-7448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS016946L
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: