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General NPI Number Information
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NPI Number | 1447621669
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Entity Type | Organization
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Legal Business Name | WESTERN PENNSYLVANIA DENTAL GROUP
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 04/18/2022
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Provider Practice Location Address
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Address Line | 9170 COVENANT AVE BLDG A-2
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City | PITTSBURGH
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State | PA
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Zip | 15237-5961
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Country | US
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Telephone | 412-548-0184
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Fax |
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Provider Business Mailing Address
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Address Line | 9170 COVENANT AVE BLDG A-2
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City | PITTSBURGH
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State | PA
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Zip | 15237-5961
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Country | US
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Telephone | 412-548-0184
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | CELIA HAYES
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Credential |
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Telephone | 217-540-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DS029676
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License Number State | PA
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Taxonomy #2
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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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