Provider Demographics
NPI:1427587047
Name:THREE RIVERS DENTAL GROUP/UPPER ST. CLAIR/LLC
Entity Type:Organization
Organization Name:THREE RIVERS DENTAL GROUP/UPPER ST. CLAIR/LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLIRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-978-1010
Mailing Address - Street 1:86 FORT COUCH RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-1020
Mailing Address - Country:US
Mailing Address - Phone:412-833-9540
Mailing Address - Fax:412-833-9546
Practice Address - Street 1:86 FORT COUCH RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-1020
Practice Address - Country:US
Practice Address - Phone:412-833-9540
Practice Address - Fax:412-833-4525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021586L122300000X
PADS017612L1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty