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General NPI Number Information
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NPI Number | 1417420175
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Entity Type | Organization
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Legal Business Name | LIVEWELL DENTISTRY OF OAKLAND
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Dates
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Enumeration Date | 01/05/2019
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Last Update Date | 01/05/2019
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Provider Practice Location Address
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Address Line | 410 S CRAIG ST STE 102
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City | PITTSBURGH
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State | PA
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Zip | 15213-3709
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Country | US
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Telephone | 412-621-1356
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Fax |
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Provider Business Mailing Address
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Address Line | 410 S CRAIG ST STE 102
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City | PITTSBURGH
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State | PA
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Zip | 15213-3709
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Country | US
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Telephone | 412-621-1356
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Fax |
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Authorized Official
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Title or Position | OWNDER
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Name | LESLIE PASCO
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Credential | DDS
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Telephone | 412-621-1356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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