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General NPI Number Information
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NPI Number | 1770854549
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Entity Type | Organization
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Legal Business Name | PEACH STREET DENTAL & DENTURES, PC.
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 01/25/2012
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Provider Practice Location Address
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Address Line | 7040 PEACH ST
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City | ERIE
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State | PA
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Zip | 16509
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Country | US
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Telephone | 814-866-7500
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Fax | 814-866-7555
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Provider Business Mailing Address
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Address Line | 7040 PEACH ST
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City | ERIE
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State | PA
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Zip | 16509
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Country | US
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Telephone | 814-866-7500
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Fax | 814-866-7555
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMAN U SYED
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Credential |
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Telephone | 716-400-1868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 126900000X
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Taxonomy Name | Dental Laboratory Technician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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