Healthcare Provider Details

I. General information

NPI: 1639161706
Provider Name (Legal Business Name): MELVIN D FEDERBUSCH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 LINCOLN WAY
WHITE OAK PA
15131-1600
US

IV. Provider business mailing address

1432 LINCOLN WAY
WHITE OAK PA
15131-1600
US

V. Phone/Fax

Practice location:
  • Phone: 412-672-9657
  • Fax:
Mailing address:
  • Phone: 412-672-9657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS015365L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: