=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720747231
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BUFALINI PEDIATRIC DENTISTRY, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2021
-----------------------------------------------------
Last Update Date | 12/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 WEYMAN RD STE 480
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15236-1520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-877-3608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 BAYARD RD APT 116
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15213-1904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-877-3608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PEDIATRIC DENTIST
-----------------------------------------------------
Name | DR. GINA BUFALINI
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 412-877-3608
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------