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General NPI Number Information
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NPI Number | 1104298728
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Entity Type | Organization
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Legal Business Name | COMPLETE DENTAL CARE OF WHITAKER
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Dates
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Enumeration Date | 10/22/2015
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 107 WHITAKER ST
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City | HOMESTEAD
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State | PA
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Zip | 15120-2411
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Country | US
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Telephone | 412-462-7710
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Fax | 412-462-7710
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Provider Business Mailing Address
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Address Line | 107 WHITAKER ST
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City | HOMESTEAD
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State | PA
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Zip | 15120-2411
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Country | US
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Telephone | 412-462-7710
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Fax | 412-462-7710
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. ROBERT A DOYLE JR.
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Credential | DMD
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Telephone | 412-462-7710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS037954
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS035693
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License Number State | PA
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