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General NPI Number Information
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NPI Number | 1588464960
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Entity Type | Organization
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Legal Business Name | INDEPENDENT DENTAL IMPLANT SERVICES, LLC
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Dates
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Enumeration Date | 03/15/2025
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Last Update Date | 03/15/2025
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Provider Practice Location Address
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Address Line | 291 PATRIOT LN
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City | FREEDOM
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State | PA
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Zip | 15042-2675
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Country | US
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Telephone | 412-618-6594
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Fax |
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Provider Business Mailing Address
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Address Line | 291 PATRIOT LN
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City | FREEDOM
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State | PA
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Zip | 15042-2675
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Country | US
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Telephone | 412-618-6594
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DERON KOVAC KOVAC
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Credential | DMD
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Telephone | 412-618-6594
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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 |
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License Number State |
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