Healthcare Provider Details

I. General information

NPI: 1457323388
Provider Name (Legal Business Name): DENTALWORKS OF PLEASANT HILLS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2006
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 CLAIRTON BLVD.
PITTSBURGH PA
15236
US

IV. Provider business mailing address

17300 DALLAS PKWY #1070
DALLAS TX
75248
US

V. Phone/Fax

Practice location:
  • Phone: 724-523-2518
  • Fax: 724-523-2382
Mailing address:
  • Phone: 800-487-4867
  • Fax: 216-584-1750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ISAM IBRAHIM
Title or Position: PC OWNER
Credential: D.M.D.
Phone: 724-523-2818