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General NPI Number Information
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NPI Number | 1447422282
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Entity Type | Organization
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Legal Business Name | SHENANGO VALLEY ORTHODONTICS, LLC
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 701 N HERMITAGE RD SUITE 21
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City | HERMITAGE
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State | PA
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Zip | 16148-3234
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Country | US
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Telephone | 724-981-8421
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Fax | 724-981-0111
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Provider Business Mailing Address
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Address Line | 701 N HERMITAGE RD SUITE 21
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City | HERMITAGE
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State | PA
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Zip | 16148-3234
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Country | US
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Telephone | 724-981-8421
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Fax | 724-981-0111
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Authorized Official
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Title or Position | TREASURER
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Name | MRS. DEBORAH KAY SMITH
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Credential |
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Telephone | 724-981-8421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DS026869L
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License Number State | PA
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