Healthcare Provider Details

I. General information

NPI: 1366599896
Provider Name (Legal Business Name): TIMOTHY J SLUSER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 COLUMBIA AVE
VANDERGRIFT PA
15690-1101
US

IV. Provider business mailing address

139 COLUMBIA AVE
VANDERGRIFT PA
15690-1101
US

V. Phone/Fax

Practice location:
  • Phone: 724-567-7317
  • Fax: 724-567-1787
Mailing address:
  • Phone: 724-567-7317
  • Fax: 724-567-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS025734L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: