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General NPI Number Information
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NPI Number | 1275240244
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Entity Type | Organization
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Legal Business Name | VIVID DENTAL PLLC
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 4290 WILLIAM FLYNN HWY STE 202
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City | ALLISON PARK
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State | PA
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Zip | 15101-1443
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Country | US
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Telephone | 412-213-0075
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16008
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City | PITTSBURGH
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State | PA
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Zip | 15242-0008
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Country | US
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Telephone | 412-929-0254
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Fax | 412-920-5861
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Authorized Official
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Title or Position | PRESIDENT
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Name | MEGAN ROSS
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Credential | DMD
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Telephone | 412-929-0254
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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 |
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License Number State |
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