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General NPI Number Information
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NPI Number | 1508263468
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Entity Type | Organization
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Legal Business Name | COMPLETE FAMILY DENTISTRY
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Dates
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Enumeration Date | 11/20/2014
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 80 HUFF AVE SUITE 1
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City | GREENSBURG
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State | PA
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Zip | 15601
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Country | US
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Telephone | 724-836-3368
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Fax | 724-836-1209
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Provider Business Mailing Address
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Address Line | 80 HUFF AVE SUITE 1
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City | GREENSBURG
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State | PA
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Zip | 15601
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Country | US
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Telephone | 724-836-3368
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Fax | 724-836-1209
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Authorized Official
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Title or Position | DMD
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Name | MR. PAUL J KRAISINGER
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Credential | DMD
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Telephone | 724-244-1189
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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 | DS025226L
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License Number State | PA
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