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General NPI Number Information
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NPI Number | 1417336819
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Entity Type | Organization
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Legal Business Name | THE DENTISTS AT SHADYSIDE PLACE, LLC
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Dates
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Enumeration Date | 05/19/2015
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 580 S AIKEN AVE SUITE 620
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City | PITTSBURGH
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State | PA
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Zip | 15232-1531
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Country | US
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Telephone | 412-622-0221
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Fax | 412-622-0224
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Provider Business Mailing Address
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Address Line | 580 S AIKEN AVE SUITE 620
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City | PITTSBURGH
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State | PA
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Zip | 15232-1531
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Country | US
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Telephone | 412-622-0221
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Fax | 412-622-0224
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BOBBIE LEE HAWRANKO
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Credential | D.M.D.
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Telephone | 412-622-0221
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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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