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General NPI Number Information
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NPI Number | 1134517998
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Entity Type | Organization
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Legal Business Name | ALLEGHENY DENTAL GROUP PC
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Dates
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Enumeration Date | 01/02/2015
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Last Update Date | 01/02/2015
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Provider Practice Location Address
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Address Line | 1532 LINCOLN WAY
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City | WHITE OAK
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State | PA
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Zip | 15131-1712
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Country | US
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Telephone | 412-672-1199
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Fax | 724-978-0327
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Provider Business Mailing Address
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Address Line | 1532 LINCOLN WAY
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City | WHITE OAK
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State | PA
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Zip | 15131-1712
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Country | US
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Telephone | 412-672-1199
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Fax | 724-978-0327
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS D KRATZENBERG
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Credential | DMD
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Telephone | 412-672-1199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DS027815L
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License Number State | PA
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