Healthcare Provider Details

I. General information

NPI: 1053861799
Provider Name (Legal Business Name): ELEVATED ORAL & IMPLANT SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 BOYCE RD SUITE A
UPPER ST CLAIR PA
15241-3927
US

IV. Provider business mailing address

1131 BOYCE RD SUITE A
UPPER ST CLAIR PA
15241-3927
US

V. Phone/Fax

Practice location:
  • Phone: 724-260-5009
  • Fax: 724-299-3154
Mailing address:
  • Phone: 724-260-5009
  • Fax: 724-299-3154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MEGHAN DEISROTH BARRONER
Title or Position: PRESIDENT, OWNER
Credential: D.M.D.
Phone: 724-260-5009