Healthcare Provider Details

I. General information

NPI: 1811586357
Provider Name (Legal Business Name): FACIAL SURGERY CENTER OF MT PLEASANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 ROUTE 819
MT PLEASANT PA
15666-2665
US

IV. Provider business mailing address

1211 S MAIN ST
GREENSBURG PA
15601-5319
US

V. Phone/Fax

Practice location:
  • Phone: 724-640-4367
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. DOROTHY KNUPP
Title or Position: COO
Credential:
Phone: 724-640-4367