=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447563069
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE GOLUBIC RHOADS DMD, MBE, MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2010
-----------------------------------------------------
Last Update Date | 08/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 132 GRAHAM PARK DR SUITE 300
-----------------------------------------------------
City | CRANBERRY TWP
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16066-8330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-742-2300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 132 GRAHAM PARK DR SUITE 300
-----------------------------------------------------
City | CRANBERRY TWP
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16066-8330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-742-2300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | DS038322
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 30023208
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------