Healthcare Provider Details

I. General information

NPI: 1619521499
Provider Name (Legal Business Name): AMY BALKOVEC RDH, PHDHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 WINDMILL LN
PITTSBURGH PA
15237-6202
US

IV. Provider business mailing address

301 DANA CT
GIBSONIA PA
15044-5322
US

V. Phone/Fax

Practice location:
  • Phone: 412-364-2213
  • Fax: 412-366-6778
Mailing address:
  • Phone: 412-418-4104
  • Fax: 412-366-6778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH08202
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: