=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992700744
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENTISTRY FOR CHILDREN AND TEENS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2005
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 265 3RD ST
-----------------------------------------------------
City | BEAVER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15009-2350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-774-1920
-----------------------------------------------------
Fax | 724-774-3332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 537
-----------------------------------------------------
City | BEAVER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15009-0537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-774-1920
-----------------------------------------------------
Fax | 724-774-3332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. ROBERT ALAN DAVIS
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 724-774-1920
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------