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>> Dentist >> Dental Providers

Registrant NPI Number: 1336235100

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
Tel: 724-458-7620  Fax: 724-458-8032

Contact information for business:
Tel: 724-458-7620  Fax: 724-458-8032

Registration Information:
NPI: 1336235100
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y122300000XDental Providers

Legacy codes, insurance codes and state license numbers:



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