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General NPI Number Information
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NPI Number | 1215906268
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Entity Type | Individual
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Provider Name | IRA DAVID ATCHESON DMD
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 255 3RD ST
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City | BEAVER
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State | PA
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Zip | 15009-2350
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Country | US
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Telephone | 724-728-1700
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Fax | 724-728-1413
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Provider Business Mailing Address
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Address Line | 255 3RD ST
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City | BEAVER
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State | PA
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Zip | 15009-2350
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Country | US
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Telephone | 724-728-1700
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Fax | 724-728-1413
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | DS-017928-L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | 30-019224
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License Number State | OH
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