Healthcare Provider Details

I. General information

NPI: 1285829028
Provider Name (Legal Business Name): UPMC CHILDREN'S HOSPITAL OF PITTSBURGH DENTAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE
PITTSBURGH PA
15224
US

IV. Provider business mailing address

PO BOX 382007
PITTSBURGH PA
15251-8007
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-5440
  • Fax:
Mailing address:
  • Phone: 412-692-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number291201
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number291201
License Number StatePA

VIII. Authorized Official

Name: NICHOLAS BARCELLONA
Title or Position: CFO
Credential:
Phone: 412-692-7331