Healthcare Provider Details

I. General information

NPI: 1003011925
Provider Name (Legal Business Name): DZUBAN DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PENN CENTER BLVD SUITE 210
PITTSBURGH PA
15235
US

IV. Provider business mailing address

300 PENN CENTER BLVD SUITE 210
PITTSBURGH PA
15235
US

V. Phone/Fax

Practice location:
  • Phone: 412-825-0200
  • Fax: 412-825-4627
Mailing address:
  • Phone: 412-825-0200
  • Fax: 412-825-4627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS028795L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS026891L
License Number StatePA

VIII. Authorized Official

Name: JOHN M DZUBAN
Title or Position: GENERAL PARTNER
Credential: DMD
Phone: 412-825-0200