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General NPI Number Information
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NPI Number | 1891187753
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Entity Type | Organization
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Legal Business Name | PREMIER FAMILY DENTISTRY OF PA LLC
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 5208 CLAIRTON BLVD SUITE 2
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City | PITTSBURGH
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State | PA
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Zip | 15236-2711
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Country | US
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Telephone | 412-882-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 5208 CLAIRTON BLVD SUITE 2
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City | PITTSBURGH
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State | PA
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Zip | 15236-2711
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Country | US
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Telephone | 412-882-1700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAUL BRORING
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Credential | DDS
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Telephone | 412-882-1700
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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 | DS038177
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License Number State | PA
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