Provider Demographics
NPI:1477869675
Name:SOUTH HILLS DENTAL ARTS - INGRAM, LLC
Entity Type:Organization
Organization Name:SOUTH HILLS DENTAL ARTS - INGRAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:CRANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-334-3713
Mailing Address - Street 1:2725 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-2329
Mailing Address - Country:US
Mailing Address - Phone:412-922-9292
Mailing Address - Fax:
Practice Address - Street 1:2725 CENTER ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-2329
Practice Address - Country:US
Practice Address - Phone:412-922-9292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty