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General NPI Number Information
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NPI Number | 1750622106
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY SOUTH
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Dates
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Enumeration Date | 03/11/2013
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Last Update Date | 03/11/2013
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Provider Practice Location Address
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Address Line | 1580 MCLAUGHLIN RUN RD SUITE 204
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City | PITTSBURGH
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State | PA
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Zip | 15241-3100
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Country | US
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Telephone | 412-257-1150
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Fax | 412-257-3758
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Provider Business Mailing Address
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Address Line | 1580 MCLAUGHLIN RUN RD SUITE 204
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City | PITTSBURGH
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State | PA
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Zip | 15241
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Country | US
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Telephone | 412-257-1150
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Fax | 412-257-3758
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SARA SECRIST
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Credential | RDH
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Telephone | 412-257-1150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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