Provider Demographics
NPI:1255650297
Name:IANNESSA PEDIATRIC DENTISTRY, P.C.
Entity Type:Organization
Organization Name:IANNESSA PEDIATRIC DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:IANNESSA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-329-7267
Mailing Address - Street 1:980 BEAVER GRADE ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108
Mailing Address - Country:US
Mailing Address - Phone:412-329-7267
Mailing Address - Fax:
Practice Address - Street 1:980 BEAVER GRADE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108
Practice Address - Country:US
Practice Address - Phone:412-329-7267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0365211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty