Provider Demographics
NPI:1346645637
Name:UNIVERSITY OF PITTSBURGH SCHOOL OF DENTAL MEDICINE
Entity Type:Organization
Organization Name:UNIVERSITY OF PITTSBURGH SCHOOL OF DENTAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HECKENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-254-2109
Mailing Address - Street 1:507 SHADY AVE
Mailing Address - Street 2:APT C4
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-4448
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3501 TERRACE
Practice Address - Street 2:SALK HALL
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15261-4448
Practice Address - Country:US
Practice Address - Phone:412-648-8616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040091261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental