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General NPI Number Information
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NPI Number | 1639768930
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Entity Type | Organization
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Legal Business Name | TRDG/WASHINGTON, LLC
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 900 WILDFLOWER CIR STE 904
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City | WASHINGTON
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State | PA
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Zip | 15301-9782
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Country | US
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Telephone | 724-978-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 7000 N 39TH PL
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City | PARADISE VALLEY
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State | AZ
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Zip | 85253-3274
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Country | US
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Telephone | 724-978-1010
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE ADMINISTRATOR
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Name | MS. LORI A MILLIRON
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Credential |
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Telephone | 724-978-1010
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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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