Healthcare Provider Details

I. General information

NPI: 1922829332
Provider Name (Legal Business Name): DENTAL IMPLANT SPECIALISTS OF PENNSYLVANIA I, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 STEUBENVILLE PIKE STE 361
PITTSBURGH PA
15205-9604
US

IV. Provider business mailing address

3500 MAPLE AVE
DALLAS TX
75219-3906
US

V. Phone/Fax

Practice location:
  • Phone: 412-788-9333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: GEORGE TUNDER
Title or Position: PROVIDER PARTNER
Credential:
Phone: 412-788-9333