Provider Demographics
NPI:1295003911
Name:DENTISTRY FOR KIDS
Entity Type:Organization
Organization Name:DENTISTRY FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDISTRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRORING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,
Authorized Official - Phone:412-682-7900
Mailing Address - Street 1:4815 LIBERTY AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224
Mailing Address - Country:US
Mailing Address - Phone:412-682-7900
Mailing Address - Fax:412-682-7954
Practice Address - Street 1:4815 LIBERTY AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224
Practice Address - Country:US
Practice Address - Phone:412-682-7900
Practice Address - Fax:412-682-7954
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMAS W. JACKSON INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDS0381771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty