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General NPI Number Information
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NPI Number | 1841528999
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Entity Type | Organization
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Legal Business Name | CERTUS DENTAL CARE, LLC
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Dates
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Enumeration Date | 12/01/2009
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Last Update Date | 12/01/2009
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Provider Practice Location Address
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Address Line | 8035 MCKNIGHT RD ANDRE PLAZA SUITE 201
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City | PITTSBURGH
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State | PA
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Zip | 15237-3036
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Country | US
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Telephone | 412-364-5050
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Fax | 412-364-2387
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Provider Business Mailing Address
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Address Line | 8035 MCKNIGHT RD ANDRE PLAZA SUITE 201
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City | PITTSBURGH
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State | PA
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Zip | 15237-3036
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Country | US
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Telephone | 412-364-5050
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Fax | 412-364-2387
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. MICHAEL J HEROCK
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Credential | DMD
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Telephone | 412-364-5050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS025705L
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License Number State | PA
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