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General NPI Number Information
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NPI Number | 1073093233
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Entity Type | Organization
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Legal Business Name | BAN ORAL AND FACIAL SURGICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 08/17/2018
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 4725 MCKNIGHT RD STE 209
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City | PITTSBURGH
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State | PA
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Zip | 15237-3414
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Country | US
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Telephone | 412-367-3020
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Fax | 412-367-5940
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Provider Business Mailing Address
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Address Line | 4725 MCKNIGHT RD STE 209
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City | PITTSBURGH
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State | PA
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Zip | 15237-3414
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Country | US
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Telephone | 412-367-3020
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Fax | 412-367-5940
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LAURIE D. FRANK
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Credential |
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Telephone | 412-367-3020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS022496L
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License Number State | PA
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