Healthcare Provider Details

I. General information

NPI: 1356264469
Provider Name (Legal Business Name): JILLIAN ROSE LUCCHETTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 DELAFIELD RD
PITTSBURGH PA
15215-1802
US

IV. Provider business mailing address

294 FOSTERVILLE RD
GREENSBURG PA
15601-6869
US

V. Phone/Fax

Practice location:
  • Phone: 724-822-2130
  • Fax:
Mailing address:
  • Phone: 724-309-7644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS045940
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: