Provider Demographics
NPI:1144356122
Name:GESHAY PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:GESHAY PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:GESHAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:724-138-7007
Mailing Address - Street 1:634 PITTSBURGH ROAD
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401
Mailing Address - Country:US
Mailing Address - Phone:724-439-1576
Mailing Address - Fax:724-438-7007
Practice Address - Street 1:634 PITTSBURGH ROAD
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401
Practice Address - Country:US
Practice Address - Phone:724-439-1576
Practice Address - Fax:724-438-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022241L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009326300002Medicaid
147782OtherUNITED CONCORDIA
147782OtherUNITED CONCORDIA