=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811753445
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SERPIL ERTURK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2024
-----------------------------------------------------
Last Update Date | 10/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 635 ALBANY ST
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02118-3550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-358-8300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4021 JOHNS CT
-----------------------------------------------------
City | CHESWICK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15024-2370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-478-1254
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS044894
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------