Healthcare Provider Details

I. General information

NPI: 1124171632
Provider Name (Legal Business Name): ALLIED DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 SOUTH MAIN STREET
SLIPPERY ROCK PA
16057
US

IV. Provider business mailing address

234 SOUT MAIN STREET
SLIPPERY ROCK PA
16057
US

V. Phone/Fax

Practice location:
  • Phone: 724-794-2224
  • Fax: 724-794-2225
Mailing address:
  • Phone: 724-794-2224
  • Fax: 724-794-2225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH G. DEFRANCESCO
Title or Position: OWNER
Credential: D.M.D.
Phone: 724-794-2224