Provider Demographics
NPI:1417336819
Name:THE DENTISTS AT SHADYSIDE PLACE, LLC
Entity Type:Organization
Organization Name:THE DENTISTS AT SHADYSIDE PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HAWRANKO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-622-0221
Mailing Address - Street 1:580 S AIKEN AVE
Mailing Address - Street 2:SUITE 620
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1531
Mailing Address - Country:US
Mailing Address - Phone:412-622-0221
Mailing Address - Fax:412-622-0224
Practice Address - Street 1:580 S AIKEN AVE
Practice Address - Street 2:SUITE 620
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1531
Practice Address - Country:US
Practice Address - Phone:412-622-0221
Practice Address - Fax:412-622-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty