Provider Demographics
NPI:1134517998
Name:ALLEGHENY DENTAL GROUP PC
Entity Type:Organization
Organization Name:ALLEGHENY DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:KRATZENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-672-1199
Mailing Address - Street 1:1532 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:PA
Mailing Address - Zip Code:15131-1712
Mailing Address - Country:US
Mailing Address - Phone:412-672-1199
Mailing Address - Fax:724-978-0327
Practice Address - Street 1:1532 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131-1712
Practice Address - Country:US
Practice Address - Phone:412-672-1199
Practice Address - Fax:724-978-0327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027815L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental