Healthcare Provider Details

I. General information

NPI: 1700849742
Provider Name (Legal Business Name): ALLEGHENY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E NORTH AVE
PITTSBURGH PA
15212-4756
US

IV. Provider business mailing address

320 E NORTH AVE
PITTSBURGH PA
15212-4756
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-6001
  • Fax: 412-359-4063
Mailing address:
  • Phone: 412-359-6001
  • Fax: 412-359-4063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DENISE NOEL
Title or Position: DIRECTOR PROVIDER ENROLLMENT
Credential:
Phone: 412-770-6871