Healthcare Provider Details

I. General information

NPI: 1689301517
Provider Name (Legal Business Name): CASEY JAN LALLY D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 CHAUVET DR
PITTSBURGH PA
15275-1050
US

IV. Provider business mailing address

530 CHAUVET DR
PITTSBURGH PA
15275-1050
US

V. Phone/Fax

Practice location:
  • Phone: 412-876-8003
  • Fax: 412-859-3040
Mailing address:
  • Phone: 412-876-8003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS043242
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: