Provider Demographics
NPI:1316403454
Name:PENN DENTAL SOLUTIONS LLC
Entity Type:Organization
Organization Name:PENN DENTAL SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:BIENVENIDO
Authorized Official - Last Name:MINAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-232-7985
Mailing Address - Street 1:3055 WASHINGTON RD STE 303
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3279
Mailing Address - Country:US
Mailing Address - Phone:724-942-5630
Mailing Address - Fax:724-942-5632
Practice Address - Street 1:3055 WASHINGTON RD STE 303
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-3279
Practice Address - Country:US
Practice Address - Phone:724-942-5630
Practice Address - Fax:724-942-5632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental